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

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

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6 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)281-293
Number of pages13
JournalDementia and Geriatric Cognitive Disorders
Volume43
Issue number5-6
DOIs
Publication statusPublished - Jun 1 2017
Externally publishedYes

Keywords

  • Chronic kidney disease
  • dementia
  • End of life care
  • End-stage renal disease
  • Mortality
  • Transition

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Cognitive Neuroscience
  • Psychiatry and Mental health

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    Molnar, M. Z., Sumida, K., Gaipov, A., Potukuchi, P. K., Fülöp, T., Joglekar, K., Lu, J. L., Streja, E., Kalantar-Zadeh, K., & Kovesdy, C. P. (2017). Pre-ESRD Dementia and Post-ESRD Mortality in a Large Cohort of Incident Dialysis Patients. Dementia and Geriatric Cognitive Disorders, 43(5-6), 281-293. https://doi.org/10.1159/000471761