Aortic Blood Pressure and Cognitive Function in Frail Kidney Transplant Candidates

Introduction: The prevalence of older individuals with end stage kidney disease requiring a kidney transplant has increased. Older transplant candidates are more susceptible to frailty and cognitive impairment, both of which are associated with poor transplant outcome. Therefore, investigations into the physiological contributors to cognitive impairment in frail kidney transplant candidates are warranted. The objective of this study was to examine the relationship between central arterial hemodynamics and cognitive function in frail kidney transplant candidates. The hypothesis was that low aortic blood pressure would be associated with worse cognitive function. Methods: 17 kidney transplant candidates (Mean ± SD, 65 ± 9 yrs; 65% female; 59% Black) were enrolled. Frailty was assessed according to the Fried Physical Frailty criteria. Central aortic hemodynamics were derived from radial artery applanation tonometry and the use of the general transfer function. Spatial planning and working memory subdomains of executive function were assessed with the One Touch Stockings Test of Cambridge (OTS). Results: 53% and 47% of patientsreported a physical pre-frail and frail phenotype, respectively. Central aortic systolic blood pressure (117 ± 20 mmHg) was positively associated with the number of problems solved on the first choice (11 ± 5; r = 0.55, p = 0.02) and negatively associated with the mean number of choices to correct choice (2 ± 1; r = -0.61, p = 0.01) on the OTS. Thus, on the OTS patients with a lower central systolic blood pressure solved fewer problems on their first choice and performed more choices before making the correct choice. Conclusions: In pre-frail and frail transplant candidates, we observed a paradoxical relationship between central blood pressure and cognitive function, with patients with lower aortic blood pressures reporting worse executive function. These preliminary findings may inform future physiological studies of cerebral blood flow and cognitive function in end stage kidney disease. In addition, these findings should be confirmed in larger epidemiological studies that may guide blood pressure treatment targets in frail kidney transplant candidates. Funding: Virginia Commonwealth University Department of Internal Medicine and the Gupta-Levy Transplant Endowment Fund. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.