Pre-ESRD Dementia and Post-ESRD Mortality in a Large Cohort of Incident Dialysis Patients

Abstract

Background: Conservative management may be a desirable option for elderly, fragile, or demented patients who reach end-stage renal disease (ESRD), yet some patients with dementia are placed on renal replacement therapy nonetheless. Methods: From a nationwide cohort of 45,076 US veterans who transitioned to ESRD over 4 contemporary years (October 1, 2007 to September 30, 2011), we identified 1,336 (3.0%) patients with International Classification of Diseases, Ninth Revision, Clinical Modification code-based dementia diagnosis during the prelude (predialysis) period. We examined the association of prelude dementia with all-cause mortality within the first 6 months following transition to dialysis, using a propensity-matched cohort and Cox proportional hazards models. Results: In the entire cohort, the overall mean ± standard deviation age at baseline was 72 ± 11 years, 95% were male, 23% were African-American, and 66% were diabetic. There were 8,080 (18.5%) deaths (mortality rate, 412; 95% confidence interval [CI], 403-421/1,000 patient-years) in the dementia-negative group, and 396 (29.6%) deaths (mortality rate, 708; 95% CI, 642-782/1,000 patient-years) in the dementia-positive group in the entire cohort in the first 6 months after dialysis initiation. Presence of dementia was associated with higher risk of all-cause mortality (adjusted hazard ratio, 1.25; 95% CI, 1.12-1.38) compared to dementia-free patients in the first 6 months after dialysis initiation. Conclusion: Pre-ESRD dementia is associated with increased risk of early post-ESRD mortality in veterans transitioning to dialysis.

Association between dementia diagnosis at dialysis initiation and mortality in older patients with end-stage kidney disease in South Korea

“…hospitalization. These findings are consistent with those of recent studies, which reported that the presence of dementia before dialysis increased the risk of postdialysis mortality by 19% to 30% [18,19]. Multiple factors, such as increased cardiac and cerebrovascular risks [19], frailty [14,20], impeding treatment adherence [21], and comorbidities [22], may contribute to post-ESKD mortality in dementia.…”

“…In addition, the Korean population has been rapidly growing older, and the age-standardized annual prevalence rate of AD in Korea has increased from 3.17 in 2006 to 15.75 in 2015 (events per 1,000 persons) [26]. A cohort study of veterans in the United States conducted between 2007 and 2011 revealed that 3.0% of incident dialysis patients had dementia, highlighting that nearly 50% of patients with dementia died within a year of dialysis initiation [18]. Given the increased prevalence and aggravated mortality risk associated with dementia in patients with ESKD, cognitive assessment of patients with ESKD before dialysis initiation may be instructive.…”

Health‐care use and cost for multimorbid persons with dementia in the National Health and Aging Trends Study

“…A substantial proportion of this population cohort (29%) had chronic kidney disease. Dementia is associated with an increased risk of death in individuals with end stage renal disease 39 and in dialysis patients 37 . Hospitalization is often required for older adults with glomerular diseases due to comorbidity and higher risk of cardiovascular complications.…”

Predialysis coronary revascularization and postdialysis mortality

“…We studied longitudinal data from the Transition of Care in CKD (TC-CKD) study, a historical cohort study examining US veterans with incident ESRD transitioning to dialysis from October 1, 2007 through March 31, 2014. 27,28 A total of 85,505 US veterans were identified from the US Renal Data System (USRDS) 29 as a source population. The algorithm for the cohort definition is shown in Figure 1.…”