2025/11/01 by Jingyao Hong, Malika Wilson, Jane J. Long +9
paper · doi:10.1111/ctr.70376
ABSTRACT Background Older patients who are evaluated for kidney transplantation (KT) experience an earlier onset of cognitive impairment due to dialysis, comorbidities, and inactivity. Ambient fine particulate matter (PM 2.5 ) is a modifiable risk factor for dementia among community‐dwelling older adults. Inflammatory responses and oxidative stress caused by inactivity in older patients evaluated for KT may heighten vulnerability to PM 2.5 . Thus, the impact of PM 2.5 on dementia may be more severe in this population. Methods We leveraged a prospective cohort (2009–2019) of older (age ≥ 50) patients evaluated for KT ( n = 2073) with Modified Mini‐Mental State Examination (3MS). We derived annual PM 2.5 from residential ZIP codes (high: PM 2.5 > 9 µg/m 3 ), quantifying its association with global cognitive function (linear regression), impairment (logistic regression), and risk of dementia (Cox proportional hazards model). We tested the interaction between PM 2.5 and dementia risk factors using a Wald test. Models were adjusted for confounders, including social determinants of health. Results High PM 2.5 was associated with worse global cognitive function (difference = −3.00 points [3MS score], 95% CI: −3.93 to −2.07), with a stronger association among patients with low physical activity ( p [interaction] 2.5 was associated with 1.90‐fold higher odds of global cognitive impairment (95% CI: 1.48–2.46), and 3.29‐fold higher risk of dementia (95% CI: 1.14–9.55). Conclusion High PM 2.5 was associated with worse cognitive function among older patients evaluated for KT, particularly those with low physical activity. The association was stronger than prior findings among community‐dwelling older adults. Clinicians may counsel patients to monitor air quality. Patients in high PM 2.5 neighborhoods should discuss cognitive assessments and ways to increase physical activity with providers.