Up to 38% of patients with end-stage renal disease experience cognitive impairment. The risk for developing neurocognitive impairment is increased in patients on maintenance hemodialysis and is associated with increases in disease progression and recovery time. Patients who are referred to evaluation for placement on the kidney transplant waitlist may or may not be referred to neurocognitive evaluation (NCE).
Barcenia Morgan, MD, and colleagues at the University of Texas Medical Branch, Galveston, Texas, conducted a retrospective cohort study to examine the discrepancies between referred and nonreferred patients in waitlist placement rates, transition time from initial evaluation to waitlist, and selection for transplant surgery. The researchers reported results of the study during a poster session at the National Kidney Foundation Spring Clinical Meetings 2023 in a poster titled Renal Transplant Transition Rates After Neurocognitive Evaluation in ESRD.
The study cohort included 1719 patients evaluated for kidney transplant from January 2015 to December 2019 at a single center. The cohort was divided into two groups: (1) 155 patients who were referred for NCE prior to consideration for renal transplant and (2) 1564 patients who were not referred for NCE.
The researchers compared outcomes between the two groups, including waitlist rates, time from evaluation to waitlist assignment, and rates of transplant surgery. P values were calculated to compare referred and nonreferred patients for each of the three outcomes. Patient demographics, medications, and comorbidities were also reviewed.
Of the patients included in the overall cohort, approximately 9.0% were referred for NCE prior to consideration for renal transplant. Of the overall cohort, 48.4% were female, 25.2% were non-Hispanic White, 37.4% were non-Hispanic Black, and 34.8% were Hispanic. Among the patients referred for NCE, 32.9% had depression, 29.2% had anxiety, and 16.8% had a previous cerebral vascular accident.
Among the group referred for NCE, 36.8% were placed on the waitlist, compared with 49.6% of those not referred for NCE (P=.002). The time of transition from evaluation to waitlist placement was 7.5 months among patients in the NCE group compared with 4.6 months among patients in the nonreferred group (P=.003). Rates of kidney transplant were 15.5% in the group referred for NCE and 18.2% in the group not referred for NCE (P=.444).
In conclusion, the authors said, “Candidates without NCE referral were placed on the kidney transplant waitlist significantly faster and had a higher rate of placement overall. Nonreferred patients had an insignificantly higher rate of transplant surgery. Thus, in eligible [end-stage renal disease] ESRD patients, NCE referral may be corelated with longer time-to-waitlist, lower waitlist attainment rates, and lower transplant surgery attainment rates.”
Source: Morgan B, McCoy M, Thomas D, Garate D, Kueht M, Samper-Ternent R. Renal transplant rates after neurocognitive evaluation in ESRD. Poster #433. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2023; April 11-15, 2023; Austin, Texas.