Cognitive Function and Uremic Toxins after Kidney Transplantation: An Exploratory Study

Abstract

Background: Cognitive functions are altered in patients with CKD. However, it is suggested that cognitive functions improve after kidney transplantation, at least partially. A possible cause for this improvement could be the reduction of uremic retention solutes after transplantation. This study assessed the association between the changes in uremic toxin concentration with the changes in cognitive function in patients after kidney transplantation.

Methods: Ten recipients of kidney transplants were compared with 18 controls (nine patients on hemodialysis, and nine patients with CKD stage 4 or 5 [eGFR <30 ml/min per 1.73 m²] who were not on dialysis). An extensive neuropsychological assessment, covering the five major cognitive domains (i.e., memory, attention and concentration, information processing speed, abstract reasoning, and executive function), was done before transplantation, at 1 week post-transplant, and 3 months after transplantation. Similarly, assessments of the 18 matched, control patients were performed longitudinally over a period of 3-5 months. Concentrations of 16 uremic retention solutes (indoxyl glucuronide, p-cresyl glucuronide, phenylglucuronide, 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid, indoxyl sulfate, p-cresyl sulfate, hippuric acid, phenyl sulfate, kynurenine, tryptophan, kynurenic acid, tyrosine, indole-3-acetic acid, phenylalanine, trimethylamine N-oxide, and phenylacetylglutamine) were measured in serum samples collected at the time of the neuropsychological assessments.

Results: A significant improvement in cognitive function was only found in the processing-speed domain, and this was observed in both patients who received a transplant and patients with CKD. No significant differences between patients who received a transplant and the control groups were seen in the other cognitive domains. As expected, the serum concentration of most uremic toxins decreased significantly within 1 week after kidney transplantation.

Conclusions: There was no significant improvement in cognitive function that could be specifically related to kidney transplantation in the first 3 months after the procedure. These data do not support the notion that uremic toxins exert an immediate effect on cognitive function.

Keywords: biological toxins; cognition; kidney transplantation; transplantation.