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Background & Hypothesis: Cognitive impairment is common in patients being evaluated for a kidney transplant (KT). The association between pretransplant cognitive function and posttransplant outcomes is unclear. Study Design: We performed a prospective cohort study to assess the association between pretransplant cognitive function and clinically relevant posttransplant outcomes. Setting and Population: In this single center study, participants from the transplant clinic were evaluated during their pretransplant clinic visits and followed prospectively. Outcomes: Our primary outcome measure was allograft function. Secondary outcomes were length of hospitalization for KT, hospital readmission within 30 and 90 days, graft loss, graft rejection within 90 days and 1 year, and mortality. Analytic Approach: We measured cognitive function with the Montreal Cognitive Assessment (MoCA) test. We assessed the association of pretransplant MoCA score with posttransplant outcomes; we used linear mixed effects models to assess the association with the change in estimated glomerular filtration rate, Poisson regression for length of hospitalization, Cox proportional hazard model for graft loss and mortality, and a logistic regression model for readmission and rejection. Results: We followed 501 participants for 2.7 ± 1.5 years. The mean age of the patients was 53 ± 14 years and the mean pretransplant MoCA score was 25 ± 3. Lower pretransplant MoCA scores did not adversely affect the primary outcome of allograft function or the secondary outcomes. Although higher MoCA scores predicted a higher decline in graft function (ß = -0.28, 95% CI: -0.55 to -0.01, P = 0.04), the effect was small and not clinically significant. Older age was associated with longer hospitalization, lower likelihood of rejection, and higher mortality. Deceased donor KT (vs living donor KT) was associated with longer hospitalization but better graft function. Longer time receiving dialysis before KT was associated with longer hospitalization. A history of diabetes mellitus was associated with higher mortality. Limitations: Single center study limiting generalizability. Conclusions: Pretransplant MoCA scores were not associated with the primary outcome of allograft function or the secondary outcomes.

Cognitive impairment (problems with memory and thinking) is common in patients with kidney disease. Cognitive impairment is associated with problems following instructions and remembering to take medications. Medical adherence is important in kidney transplant recipients, and inability to follow instructions and missed doses of immunosuppression increases the risk of rejection of the transplanted kidney. However, kidney transplantation also improves cognition. Hence, transplant centers wonder if cognitive impairment before transplant affects clinical outcomes after kidney transplant. We tried to answer this question by assessing cognitive function before transplantation and examining whether pretransplant cognitive function affects graft function, length of hospitalization, readmission after transplantation, rejection, and death. We did not find any strong link between cognitive function before transplant and these outcomes.

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End-stage kidney disease has been associated with cognitive impairment and brain atrophy. It remains unclear if mild to moderate kidney dysfunction is associated with brain atrophy, especially in older adults. We used cross-sectional data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), an NIH-funded multicenter longitudinal cohort study, to better understand the association between estimated glomerular filtration rate (eGFR) and brain volumes. We included all ADNI participants with both baseline serum creatinine values and MRI brain volume assessments. We used multiple linear regression modeling to assess cross-sectional associations between eGFR and whole-brain gray matter, hippocampus, entorhinal, fusiform, and middle temporal brain volumes. Participants (n = 1,596) were 74 ± 7 years old with a mean eGFR of 69.4 ± 14.8 mL/min/1.73 m2; 53% had mild cognitive impairment, and 19% had dementia. Unadjusted analysis showed an association between lower eGFR and smaller brain volumes. After adjusting for age, sex, and education, there was no association between eGFR brain volumes (p > 0.05 for all). These results remained consistent after subgroup analysis by age stratification and baseline cognitive status. Age was a confounding variable in the unadjusted association between the eGFR and brain volumes. Thus, a mild to moderately reduced eGFR was not associated with brain atrophy in ADNI participants.

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BACKGROUND: Whether mild to moderately low estimated glomerular filtration rate (eGFR) is associated with cognitive decline in older adults is not clear. We evaluated changes in cognition in relation to baseline eGFR in older adults participating in the Alzheimer's Disease Neuroimaging Initiative (ADNI). METHODS: This is a longitudinal secondary analysis of an established observational cohort. We used data from the ADNI, an National Institutes of Health-funded, multicenter longitudinal observational study that includes participants with and without cognitive impairment who were administered a comprehensive battery of neuropsychological tests every 6 months. We related the Chronic Kidney Disease Epidemiology Collaboration eGFR with previously validated cognition composite scores for memory (ADNI-Mem) and executive function (ADNI-EF) in multivariable linear regression analysis adjusted for age, sex, race and level of education. RESULTS: A total of 1127 ADNI participants (mean age 74 ± 7 years, 57% men, 97% Caucasian, mean follow-up 6 ± 2.6 years) were included in the analysis. The mean baseline eGFR was 76 ± 19 mL/min/1.73 m2, with 6% with eGFR <45, 22% with eGFR 45-<60, 51% with eGFR 60-90 and 21% with eGFR >90 mL/min/1.73 m2 at baseline. Both ADNI-Mem and ADNI-EF scores declined over time. In the multivariable linear regression model, older age (ß = -0.117, P = 0.01), female sex (ß = 0.312, P < 0.001) and lower education (ß = 0.079, P < 0.001) were associated with a decline in ADNI-Mem scores, whereas baseline eGFR (each 10 mL/min/1.73 m2 change) was not {ß = -0.03 [confidence interval (CI) -0.06-0.001], P = 0.11}. Similarly, older age (ß = -0.278, P < 0.001) and lower education (ß = 0.099, P < 0.001) were associated with a decline in ADNI-EF scores, whereas baseline eGFR was not [ß = 0.004 (95% CI -0.04-0.04), P = 0.84]. CONCLUSIONS: In this cohort from the ADNI study, there was no association between baseline eGFR and cognitive decline in older adults with mild to moderately low eGFR.

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The LS and HS are rat lines selectively bred for altered cocaine self-administration. Given the importance of mental health in substance use, these lines were evaluated for putative depression- and anxiety- like behaviors through forced swimming and exploration of a plus maze. We found increases of struggling in LS males, climbing in LS females, and swimming in HS males; with biphasic effects on immobility in the HS strain. HS rats had fewer entries into and less time spent in open arms of the plus maze, consistent with greater anxiety-like behavior, which may contribute to enhanced drug taking.

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