title: Dementia and Alzheimer's Disease among Older Kidney Transplant Recipients.
abstract: Older patients with ESRD who receive a kidney transplant (KT) may develop post-KT dementia and Alzheimer's disease (AD) associated with their long-standing kidney disease and/or neurotoxic immunosuppressant agents. To investigate this possibility, we studied 40,918 older (aged ≥55 years) KT recipients (January 1, 1999 to December 31, 2011) linked to Medicare claims through the US Renal Data System. We estimated dementia and AD risk (cumulative incidence) and studied factors associated with these sequelae using competing risks models. We estimated the risk of death-censored graft loss and mortality after developing dementia or the AD subtype of dementia, separately, using adjusted Cox proportional hazards models. Older recipients had a 10-year dementia risk ranging from 5.1% for recipients aged 55-60 years to 17.0% for recipients aged ≥75 years; 10-year AD risk ranged from 1.0% to 6.7%, respectively. The strongest predictors for dementia and AD were older recipient age and pretransplant diabetes. The 10-year graft loss risk was 28.8% for those who did not develop dementia and 43.1% for those who did, and the corresponding mortality risks were 55.7% and 89.9%, respectively. Older recipients with dementia had a 1.52-fold (95% confidence interval, 1.39 to 1.68) increased risk of graft loss and a 2.38-fold (95% confidence interval, 2.26 to 2.49) increased risk of mortality. We observed similar results for AD. We conclude that older KT recipients have a high risk of post-KT dementia and AD, and these sequelae associate with a profound effect on patient and graft survival.
authors.affiliation: Departments of Surgery, mara@jhu.edu dorry@jhmi.edu.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; and.
authors.forename: Mara A
authors.initials: MA
authors.lastname: McAdams-DeMarco
authors.affiliation: Departments of Surgery.
authors.forename: Sunjae
authors.initials: S
authors.lastname: Bae
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; and.
authors.forename: Nadia
authors.initials: N
authors.lastname: Chu
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; and.
authors.forename: Alden L
authors.initials: AL
authors.lastname: Gross
authors.affiliation: Anesthesiology & Critical Care Medicine, and.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Brown
authors.affiliation: Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Esther
authors.initials: E
authors.lastname: Oh
authors.affiliation: Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Paul
authors.initials: P
authors.lastname: Rosenberg
authors.affiliation: Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Karin J
authors.initials: KJ
authors.lastname: Neufeld
authors.affiliation: Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Ravi
authors.initials: R
authors.lastname: Varadhan
authors.affiliation: Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Albert
authors.affiliation: Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Walston
authors.affiliation: Departments of Surgery, mara@jhu.edu dorry@jhmi.edu.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; and.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000367:Age Factors; D000368:Aged; D000544:Alzheimer Disease / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D018570:Risk Assessment
keywords: dementia; epidemiology and outcomes; kidney transplantation