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. 2017;43(5-6):281-293.
doi: 10.1159/000471761. Epub 2017 Apr 28.

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

Miklos Z Molnar  1 , Keiichi Sumida, Abduzhappar Gaipov, Praveen K Potukuchi, Tibor Fülöp, Kiran Joglekar, Jun Ling Lu, Elani Streja, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
Affiliations

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

Miklos Z Molnar et al. Dement Geriatr Cogn Disord. 2017.

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.

Keywords: Chronic kidney disease; End of life care, dementia; End-stage renal disease; Mortality; Transition.

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Conflict of interest statement

DISCLOSURES

None of the authors have relevant conflicts of interest.

Figures

Figure 1
Figure 1
Algorithm for the cohort definition.
Figure 2
Figure 2
Associations between presence of dementia and all- cause mortality in the propensity- matched cohort during the first 6-month period.
Figure 3
Figure 3
Adjusted hazard ratios (95% CIs) of presence of dementia for all-cause mortality in the first 6 months after dialysis initiation in selected subgroups. CHF, congestive heart failure; CI, confidence interval; CVD, cerebrovascular disease; HR, hazard ratio
Figure 4
Figure 4
Associations between presence of dementia and all- cause mortality in the entire cohort during the first 6-month period.
See this image and copyright information in PMC

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