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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Vydáno v:	Journal of the American Society of Nephrology Ročník 29; číslo 6; s. 1752
Hlavní autoři:	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
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.06.2018
Témata:	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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Shrnutí:	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.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1533-3450 1533-3450
DOI:	10.1681/ASN.2018010064