Incidence, Risk Factors, and Sequelae of Post-kidney Transplant Delirium

Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium. We studied 125,304 adult KT recipients (1999-2014) to estimate del...

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Veröffentlicht in:Journal of the American Society of Nephrology Jg. 29; H. 6; S. 1752
Hauptverfasser: Haugen, Christine E, Mountford, Alexandra, Warsame, Fatima, Berkowitz, Rachel, Bae, Sunjae, Thomas, Alvin, Brown, 4th, Charles H, Brennan, Daniel C, Neufeld, Karin J, Carlson, Michelle C, Segev, Dorry L, McAdams-DeMarco, Mara
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.06.2018
Schlagworte:
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Cognition
Delirium - epidemiology
Delirium - etiology
Frailty - epidemiology
Graft Survival
Humans
Incidence
Kidney Transplantation - adverse effects
Kidney Transplantation - mortality
Length of Stay - statistics & numerical data
Longitudinal Studies
Middle Aged
Patient Discharge - statistics & numerical data
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Rehabilitation Centers - statistics & numerical data
Risk Factors
Skilled Nursing Facilities - statistics & numerical data
United States - epidemiology
Young Adult
United States
epidemiology
clinical
geriatric nephrology
transplant outcomes
kidney transplantation
ISSN:1533-3450, 1533-3450
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Zusammenfassung:Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium. We studied 125,304 adult KT recipients (1999-2014) to estimate delirium incidence in national registry claims. Additionally, we used a validated chart abstraction algorithm to identify post-KT delirium in 893 adult recipients (2009-2017) from a cohort study of frailty. Delirium sequelae were identified using adjusted logistic regression (length of stay ≥2 weeks and institutional discharge [skilled nursing or rehabilitation facility]) and adjusted Cox regression (death-censored graft loss and mortality). Only 0.8% of KT recipients had a delirium claim. In the cohort study, delirium incidence increased with age (18-49 years old: 2.0%; 50-64 years old: 4.6%; 65-75 years old: 9.2%; and ≥75 years old: 13.8%) and frailty (9.0% versus 3.9%); 20.0% of frail recipients aged ≥75 years old experienced delirium. Frailty was independently associated with delirium (odds ratio [OR], 2.05; 95% confidence interval [95% CI], 1.02 to 4.13; =0.04), but premorbid global cognitive function was not. Recipients with delirium had increased risks of ≥2-week length of stay (OR, 5.42; 95% CI, 2.76 to 10.66; <0.001), institutional discharge (OR, 22.41; 95% CI, 7.85 to 63.98; <0.001), graft loss (hazard ratio [HR], 2.73; 95% CI, 1.14 to 6.53; =0.03), and mortality (HR, 3.12; 95% CI, 1.76 to 5.54; <0.001). Post-KT delirium is a strong risk factor for subsequent adverse outcomes, yet it is a clinical entity that is often missed.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1533-3450
1533-3450
DOI:10.1681/ASN.2018010064