Associations among Alzheimer disease, depressive disorder, and risk of end-stage kidney disease in elderly people

Abstract

Background: Alzheimer disease (AD) and depressive disorder (DD) are prevalent among elderly end-stage kidney disease (ESKD) patients. However, whether preexisting mental health disorders increase the risk of ESKD is not well understood. The risk of incident ESKD in patients with or without underlying AD or DD was evaluated in a nationwide cohort of elderly people in Republic of Korea. Methods: This study used data from the National Health Insurance Service-Senior cohort in Republic of Korea. Among the 558,147 total subjects, 49,634 and 54,231 were diagnosed with AD (AD group) or DD (DD group), respectively, during the follow-up period. Propensity score matching was conducted to create non-AD and non-DD groups of subjects. AD and DD diagnoses were analyzed as time-varying exposures, and the study outcome was development of ESKD. Results: The incidence rates of ESKD were 0.36 and 1.17 per 1,000 person-years in the non-AD and AD groups, respectively. After adjustment for clinical variables and competing risks of death, the risk of incident ESKD was higher in the AD group than in the non-AD group (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.34-2.08). The incidence rates of ESKD in the non-DD and DD groups were 0.36 and 0.91 per 1,000 person-years, respectively. The risk of ESKD development was also higher in the DD group than the non-DD group (HR, 1.44; 95% CI, 1.19-1.76). Conclusion:The risk of ESKD development was higher in subjects diagnosed with AD or DD, suggesting that central nervous system diseases can adversely affect kidney function in elderly people.

A troubled mind troubles the kidney: a brain-to-kidney axis?

“…Such studies will provide valuable information on a promising target of intervention with which renal function may be protected in elderly patients with depression or dementia. Given the high prevalence of these conditions in old age, the impact of such intervention would be not insignificant, as suggested by Kang et al [2].…”

“…However, the opposite relationship has not been studied well. A recent study of Kang et al [2] highlights the topic by supporting the existence of a brain-to-kidney axis [4]. This concept has been proposed based on findings that acute brain injuries from trauma or ischemic or hemorrhagic stroke coincide with acute kidney injury [5].…”

“…Dementia and depression are among the so-called 3Ds (dementia, depression, and delirium), which are most frequently encountered in geriatric psychiatry [1]. A recent report by Kang et al [2] has shown that older adults (aged >60 years) with Alzheimer dementia (AD) or depression have increased risk of end-stage kidney disease (ESKD) by 67% and 44%, respectively [2]. These figures seem to go beyond the common expectation that aging-associated illnesses are more likely to coexist.…”

Blood Pressure Control in Elderly Chronic Kidney Disease Patients

“…Age was found to be factors that predicted cognitive dysfunction at different functional levels of CKD 23) . The risk of ESKD development was higher in subjects diagnosed with Alzheimer disease, suggesting that central nervous system diseases can adversely affect kidney function in elderly people 24) .…”