Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation

Abstract

Background and objectives Older patients with ESKD experience rapid declines in executive function after initiating hemodialysis; these impairments might lead to high rates of dementia and Alzheimer's disease in this population. We estimated incidence, risk factors, and sequelae of diagnosis with dementia and Alzheimer's disease among older patients with ESKD initiating hemodialysis.Design, setting, participants, & measurements We studied 356,668 older (age $66 years old) patients on hemodialysis (January 1, 2001 to December 31, 2013) from national registry data (US Renal Data System) linked to Medicare. We estimated the risk (cumulative incidence) of diagnosis of dementia and Alzheimer's disease and studied factors associated with these disorders using competing risks models to account for death, change in dialysis modality, and kidney transplant. We estimated the risk of subsequent mortality using Cox proportional hazards models.Results The 1-and 5-year risks of diagnosed dementia accounting for competing risks were 4.6% and 16% for women, respectively, and 3.7% and 13% for men, respectively. The corresponding Alzheimer's disease diagnosis risks were 0.6% and 2.6% for women, respectively, and 0.4% and 2.0% for men, respectively. The strongest independent risk factors for diagnosis of dementia and Alzheimer's disease were age $86 years old (dementia: hazard ratio, 2.11; 95% confidence interval, 2.04 to 2.18; Alzheimer's disease: hazard ratio, 2.11; 95% confidence interval, 1.97 to 2.25), black race (dementia: hazard ratio, 1.70; 95% confidence interval, 1.67 to 1.73; Alzheimer's disease: hazard ratio, 1.78; 95% confidence interval, 1.71 to 1.85), women (dementia: hazard ratio, 1.10; 95% confidence interval, 1.08 to 1.12; Alzheimer's disease: hazard ratio, 1.12; 95% confidence interval, 1.08 to 1.16), and institutionalization (dementia: hazard ratio, 1.36; 95% confidence interval, 1.33 to 1.39; Alzheimer's disease: hazard ratio, 1.10; 95% confidence interval, 1.05 to 1.15). Older patients on hemodialysis with a diagnosis of dementia were at 2.14-fold (95% confidence interval, 2.07 to 2.22) higher risk of subsequent mortality; those with a diagnosis of Alzheimer's disease were at 2.01-fold (95% confidence interval, 1.89 to 2.15) higher mortality risk.Conclusions Older patients on hemodialysis are at substantial risk of diagnosis with dementia and Alzheimer's disease, and carrying these diagnoses is associated with a twofold higher mortality.

Risk factors for mortality in elderly haemodialysis patients: a systematic review and meta-analysis

“…This review showed that cognitive impairment in older haemodialysis patients is positively correlated to mortality. Older haemodialysis patients are also at potential risk of being befalled with Alzheimer's disease, and receiving this diagnose is associated with an increased mortality [46,47]. Another study found that dementia was associated with an increased risk of death and dialysis drop out in adults aged over 75 years on dialysis [31].…”

Frailty Prevalence in Younger End-Stage Kidney Disease Patients Undergoing Dialysis and Transplantation

“…It is well recognized that frailty is a key predictor of adverse events while on dialysis [12, 37], on the waitlist [19, 20], or during/after KT [19, 26, 38]. Consequently, clinical applications of frailty assessments have emerged, such as for improving screening.…”

Exercise and cognitive function in patients with end‐stage kidney disease

“…Additionally, impairments in executive function in patients with ESKD may suggest early signs of dementia, particularly vascular dementia, and in many cases, Alzheimer's disease . In a national study of 356 668 older patients initiating HD, the 5‐year risk of diagnosed dementia accounting for the competing risk of death and HD withdrawal was 16% for women and 13% for men; the corresponding Alzheimer's disease diagnosis risks were 2.6% for women and 2.0% for men . These older HD patients with a dementia diagnosis were at a 2‐fold higher risk of subsequent mortality, as were those with a diagnosis of Alzheimer's disease.…”