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Pre-ESRD Dementia and Post-ESRD Mortality in a Large Cohort of Incident Dialysis Patients.
- Author(s): Molnar, Miklos Z;
- Sumida, Keiichi;
- Gaipov, Abduzhappar;
- Potukuchi, Praveen K;
- Fülöp, Tibor;
- Joglekar, Kiran;
- Lu, Jun Ling;
- Streja, Elani;
- Kalantar-Zadeh, Kamyar;
- Kovesdy, Csaba P
- et al.
Published Web Locationhttps://doi.org/10.1159/000471761
BackgroundConservative 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.
MethodsFrom 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.
ResultsIn 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.
ConclusionPre-ESRD dementia is associated with increased risk of early post-ESRD mortality in veterans transitioning to dialysis.
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