Pre-ESRD dementia and post-ESRD mortality in advanced CKD patients transitioning to dialysis

Molnar M., Sumida K., Gaipov A., Potukuchi P., Lu J.L., Streja E., Kalantar-Zadeh K.

Research output: Contribution to journalArticle

Abstract

INTRODUCTION AND AIMS: Dementia is very frequently seen in elderly populations, which make up the majority of incident dialysis patients. There is increasing evidence suggesting that conservative treatment is a viable option for elderly, fragile, or demented patients compared to dialysis therapy. However, there is a paucity of evidence on the association between the presence of dementia in patients with advanced non-dialysis dependent chronic kidney disease (NDD-CKD) and postend stage renal disease (ESRD) mortality, particularly among those in the transition period from late-stage NDD-CKD to maintenance dialysis. METHODS: From a nation-wide cohort of 45,076 US veterans who transitioned to ESRD over 4 contemporary years (10/2007-09/2011), we identified 1,336 (3%) patients with a dementia diagnosis during the prelude (pre-dialysis) period according to inpatient and outpatient ICD-9-CM codes (290.x, 294.1x, 331.2x). We examined the association of prelude dementia with all-cause mortality within the first 6 months of transition to dialysis, using a propensity-matched cohort and Cox proportional hazards models. RESULTS: The overall mean+/-SD age at baseline was 77+/-9 years; 95% were male; 24% were African-American; and 71% were diabetic in the propensity-matched cohort. There were 340 deaths (25.6%, mortality rate 599 [538-666]/1000 patient-years) in the dementia negative group, and 396 deaths (29.8%, 714 [645-787]/1000 patient-years) in the dementia positive group in the propensity-matched cohort. Presence of dementia was associated with higher risk of all-cause mortality (hazard ratio: 1.19, 95% confidence interval: 1.03-1.37) compared to dementia free patients in the first 6 months after dialysis initiation. Similar results were found most subgroups. CONCLUSIONS: Pre-ESRD dementia is associated with increased risk of early post- ESRD mortality in veterans transitioning to dialysis. Clinical studies are warranted to compare survival and quality of life of dialysis treatment versus conservative treatment in patients with dementia. (Table Presented).
Original languageEnglish
JournalNephrology Dialysis Transplantation
Volume32
Issue numberSupplement 3
DOIs
Publication statusPublished - 2017

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Chronic Kidney Failure
Dementia
Dialysis
Mortality
Veterans
Chronic Renal Insufficiency
International Classification of Diseases
Proportional Hazards Models
African Americans
Inpatients
Outpatients
Maintenance
Quality of Life
Confidence Intervals
Kidney
Survival
Therapeutics
Population

Keywords

  • *dementia
  • *end stage renal disease
  • *mortality rate
  • *renal replacement therapy
  • African American
  • ICD-9-CM
  • aged
  • clinical trial
  • confidence interval
  • conservative treatment
  • controlled study
  • diabetes mellitus
  • diagnosis
  • female
  • hazard ratio
  • hospital patient
  • human
  • major clinical study
  • male
  • outpatient
  • proportional hazards model
  • quality of life
  • veteran

Cite this

Pre-ESRD dementia and post-ESRD mortality in advanced CKD patients transitioning to dialysis. / M., Molnar; K., Sumida; A., Gaipov; P., Potukuchi; J.L., Lu; E., Streja; K., Kalantar-Zadeh.

In: Nephrology Dialysis Transplantation, Vol. 32, No. Supplement 3, 2017.

Research output: Contribution to journalArticle

M., Molnar ; K., Sumida ; A., Gaipov ; P., Potukuchi ; J.L., Lu ; E., Streja ; K., Kalantar-Zadeh. / Pre-ESRD dementia and post-ESRD mortality in advanced CKD patients transitioning to dialysis. In: Nephrology Dialysis Transplantation. 2017 ; Vol. 32, No. Supplement 3.
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abstract = "INTRODUCTION AND AIMS: Dementia is very frequently seen in elderly populations, which make up the majority of incident dialysis patients. There is increasing evidence suggesting that conservative treatment is a viable option for elderly, fragile, or demented patients compared to dialysis therapy. However, there is a paucity of evidence on the association between the presence of dementia in patients with advanced non-dialysis dependent chronic kidney disease (NDD-CKD) and postend stage renal disease (ESRD) mortality, particularly among those in the transition period from late-stage NDD-CKD to maintenance dialysis. METHODS: From a nation-wide cohort of 45,076 US veterans who transitioned to ESRD over 4 contemporary years (10/2007-09/2011), we identified 1,336 (3{\%}) patients with a dementia diagnosis during the prelude (pre-dialysis) period according to inpatient and outpatient ICD-9-CM codes (290.x, 294.1x, 331.2x). We examined the association of prelude dementia with all-cause mortality within the first 6 months of transition to dialysis, using a propensity-matched cohort and Cox proportional hazards models. RESULTS: The overall mean+/-SD age at baseline was 77+/-9 years; 95{\%} were male; 24{\%} were African-American; and 71{\%} were diabetic in the propensity-matched cohort. There were 340 deaths (25.6{\%}, mortality rate 599 [538-666]/1000 patient-years) in the dementia negative group, and 396 deaths (29.8{\%}, 714 [645-787]/1000 patient-years) in the dementia positive group in the propensity-matched cohort. Presence of dementia was associated with higher risk of all-cause mortality (hazard ratio: 1.19, 95{\%} confidence interval: 1.03-1.37) compared to dementia free patients in the first 6 months after dialysis initiation. Similar results were found most subgroups. CONCLUSIONS: Pre-ESRD dementia is associated with increased risk of early post- ESRD mortality in veterans transitioning to dialysis. Clinical studies are warranted to compare survival and quality of life of dialysis treatment versus conservative treatment in patients with dementia. (Table Presented).",
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AU - K., Sumida

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AU - P., Potukuchi

AU - J.L., Lu

AU - E., Streja

AU - K., Kalantar-Zadeh

PY - 2017

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N2 - INTRODUCTION AND AIMS: Dementia is very frequently seen in elderly populations, which make up the majority of incident dialysis patients. There is increasing evidence suggesting that conservative treatment is a viable option for elderly, fragile, or demented patients compared to dialysis therapy. However, there is a paucity of evidence on the association between the presence of dementia in patients with advanced non-dialysis dependent chronic kidney disease (NDD-CKD) and postend stage renal disease (ESRD) mortality, particularly among those in the transition period from late-stage NDD-CKD to maintenance dialysis. METHODS: From a nation-wide cohort of 45,076 US veterans who transitioned to ESRD over 4 contemporary years (10/2007-09/2011), we identified 1,336 (3%) patients with a dementia diagnosis during the prelude (pre-dialysis) period according to inpatient and outpatient ICD-9-CM codes (290.x, 294.1x, 331.2x). We examined the association of prelude dementia with all-cause mortality within the first 6 months of transition to dialysis, using a propensity-matched cohort and Cox proportional hazards models. RESULTS: The overall mean+/-SD age at baseline was 77+/-9 years; 95% were male; 24% were African-American; and 71% were diabetic in the propensity-matched cohort. There were 340 deaths (25.6%, mortality rate 599 [538-666]/1000 patient-years) in the dementia negative group, and 396 deaths (29.8%, 714 [645-787]/1000 patient-years) in the dementia positive group in the propensity-matched cohort. Presence of dementia was associated with higher risk of all-cause mortality (hazard ratio: 1.19, 95% confidence interval: 1.03-1.37) compared to dementia free patients in the first 6 months after dialysis initiation. Similar results were found most subgroups. CONCLUSIONS: Pre-ESRD dementia is associated with increased risk of early post- ESRD mortality in veterans transitioning to dialysis. Clinical studies are warranted to compare survival and quality of life of dialysis treatment versus conservative treatment in patients with dementia. (Table Presented).

AB - INTRODUCTION AND AIMS: Dementia is very frequently seen in elderly populations, which make up the majority of incident dialysis patients. There is increasing evidence suggesting that conservative treatment is a viable option for elderly, fragile, or demented patients compared to dialysis therapy. However, there is a paucity of evidence on the association between the presence of dementia in patients with advanced non-dialysis dependent chronic kidney disease (NDD-CKD) and postend stage renal disease (ESRD) mortality, particularly among those in the transition period from late-stage NDD-CKD to maintenance dialysis. METHODS: From a nation-wide cohort of 45,076 US veterans who transitioned to ESRD over 4 contemporary years (10/2007-09/2011), we identified 1,336 (3%) patients with a dementia diagnosis during the prelude (pre-dialysis) period according to inpatient and outpatient ICD-9-CM codes (290.x, 294.1x, 331.2x). We examined the association of prelude dementia with all-cause mortality within the first 6 months of transition to dialysis, using a propensity-matched cohort and Cox proportional hazards models. RESULTS: The overall mean+/-SD age at baseline was 77+/-9 years; 95% were male; 24% were African-American; and 71% were diabetic in the propensity-matched cohort. There were 340 deaths (25.6%, mortality rate 599 [538-666]/1000 patient-years) in the dementia negative group, and 396 deaths (29.8%, 714 [645-787]/1000 patient-years) in the dementia positive group in the propensity-matched cohort. Presence of dementia was associated with higher risk of all-cause mortality (hazard ratio: 1.19, 95% confidence interval: 1.03-1.37) compared to dementia free patients in the first 6 months after dialysis initiation. Similar results were found most subgroups. CONCLUSIONS: Pre-ESRD dementia is associated with increased risk of early post- ESRD mortality in veterans transitioning to dialysis. Clinical studies are warranted to compare survival and quality of life of dialysis treatment versus conservative treatment in patients with dementia. (Table Presented).

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KW - end stage renal disease

KW - mortality rate

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KW - confidence interval

KW - conservative treatment

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KW - diabetes mellitus

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KW - hazard ratio

KW - hospital patient

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KW - major clinical study

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KW - quality of life

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