Cognitive decline related to chronic kidney disease as an exclusion factor from kidney transplantation: results from an international survey
Authors: Farisco Michele , Blumblyte Inga A , Franssen Casper , Nitsch Dorothea , Zecchino Irene , Capasso Giovambattista , Hafez Gaye ,   COST CONNECT Action Collaborators, Capasso Giovambattista , Andrade Alexandre , Arici Mustafa , Bachmann Maie , Bailey Matthew , Barbieri Michelangela , Bobot Mickaël , Bruchfeld Annette , Bumblyte Inga , Calcutta Antonello , Capolongo Giovanna , Carriazo Sol , Ceccarelli Michele , Covic Adrian Constantin , De Ananya , Delgado Pilar , Endlich Nicole , Endres Matthias , Esposito Fabrizio , Farisco Michele , Faucher Quentin , Ferreira Ana Carina , Figurek Andreja , Fouque Denis , Franssen Casper , Fridolin Ivo , Frische Sebastian , Garneata Liliana , Gesualdo Loreto , Giannakou Konstantinos , Godefroy Olivier , Golenia Aleksandra , Goumenos Dimitrios , Gryguc Agnė , Jiménez Eugenio Gutiérrez , Hafez Gaye , Hoorn Ewout , Silva Pedro Henrique Imenez , Izhar Raafiah , Kelly Dearbhla , Kesler Shelli , Klimkowicz-Mrowiec Aleksandra , Knauss Samuel , Kurganaite Justina , Levassort Hélène , Liabeuf Sophie , Malyszko Jolanta , Mani Laila-Yasmin , Martino Gianvito , Massy Ziad , Mayer Christopher , Mucci Armida , Mutevelic-Turkovic Alma , Nielsen Rikke , Nitsch Dorothea , Ortiz Alberto , Panagiotopoulos Vasileios , Paolisso Giuseppe , Pejušković Bojana , Pepin Marion , Perna Alessandra , Perrottelli Andrea , Pešić Vesna , Pezzella Pasquale , Rroji (Molla) Merita , Rychlík Ivan , Sakkas Giorgos , Simeoni Mariadelina , Romeo Maria José Soler , Spasovski Goce , Starčević Ana , Tedeschi Gioacchino , Trevisani Francesco , Unwin Robert , Vazelov Evgueniy , Wagner Carsten Alexander , Wagner Franca , Wanner Christoph , Wiecek Andrzej , Xu Hong , Zacchia Miriam , Zacharia Lefteris , Zecchino Irene , Zoccali Carmine , Raso Francesco Mattace , Endlich Karl Hans , Perico Norberto , Remuzzi Giuseppe , Trepiccione Francesco , Okusa Mark , Marzo Vincenzo Di , Blankestijn Peter , Eckardt Kai-Uwe , Konig Maximilian 
Published: April 2024

ABSTRACT

Background and hypothesis
There seems to be a lack of consensus on the necessity and the modality of psychological and specifically cognitive assessment of candidates for kidney transplantation. Both points are often delegated to individual hospitals/centres, whereas international guidelines are inconsistent. We think it is essential to investigate professionals' opinions to advance towards a consistent clinical practice.

Methods
This paper presents the results of an international survey among clinical professionals, mainly nephrologists from the CONNECT (Cognitive decline in Nephro-Neurology: European Cooperative Target) network and beyond (i.e. from personal contacts of CONNECT members). The survey investigated their opinions about the question of whether cognitive decline in patients with chronic kidney disease may affect their eligibility for kidney transplantation.

Results
Our results show that most clinicians working with patients affected by chronic kidney disease think that cognitive decline may challenge their eligibility for transplantation despite data that suggest that, in some patients, cognitive problems improve after kidney transplantation.

Conclusion
We conclude that three needs emerge as particularly pressing: defining agreed-on standards for a multifaceted and multifactorial assessment (i.e. including both clinical/medical and psychosocial factors) of candidates with chronic kidney disease to kidney transplantation; further investigating empirically the causal connection between chronic kidney disease and cognition; and further investigating empirically the possible partial reversibility of cognitive decline after kidney transplantation.