Influence of Kidney Transplantation on Cognitive Function in End - Stage Kidney Disease Patients

Kidney failure is believed to have a negative impact on cognitive function, and cognitive impairment is common in people with chronic kidney disease and end - stage kidney disease (ESKD). Diagnosis of cognitive impairment in this population of patients is important because cognitive impairment may have a role in the patient’s understanding and acceptance of ESKD care, both at the initiation and duration of kidney replacement therapy. The pathophysiology of cognitive impairment is uncertain; it is a complex and probably multifactorial process. It is not known whether cognitive impairment is mediated by direct toxic effects of uraemia per se, or is attributed to a high prevalence of predisposing risk factors among ESKD patients and side effects of dialysis treatment. Recent studies noted that cognitive impairment in patients with end stage renal disease is likely to improve with successful kidney transplantation and that early beneficial effects of kidney transplantation on cognitive function are not transient and were still evident one year following successful kidney transplantation.On the other hand, some cognitive limitations may still be present in kidney transplant recipients and cognitive impairment in kidney transplant recipients may impact decision-making as well the ability to adhere to transplantation recommendations, such as dietary modification and complex medication compliance. Delay in diagnosis and treatment of cognitive impairment may result in medication non adherence and subsequent severe adverse effects such as acute graft rejection. Periodic assessment of end stage renal disease patient’s cognitive function prior and post transplantation should be one of the parameters to be considered on evaluating outcomes after kidney transplantation.

Keywords: Cognitive function, kidney tran splantation, end - stage kidney disease, kidney failure, cognitive impairment, kidney replacement therapy, adherence, compliance, medical regimen, hemodialysis.