Dementia is a risk factor for major adverse cardiac and cerebrovascular events in elderly Korean patients initiating hemodialysis: a Korean national population-based study

Sung Min Jung,Ea Wha Kang,Hyung Jung Oh,Hyunwook Kim,Shina Lee,Kyoung Hoon Kim,Duk-Hee Kang,Clara Tammy Kim,Dong-Ryeol Ryu,Kyu Bok Choi,Seung-Jung Kim

doi:10.1186/s12882-017-0547-0

Abstract

BackgroundDementia is common in end-stage renal disease (ESRD) patients on hemodialysis (HD) and is associated with worse outcomes. This study aimed to investigate the risk of major adverse cardiac and cerebrovascular event (MACCE) in elderly patients with dementia initiating HD.MethodsUsing the database from the Health Insurance Review & Assessment Service, we analyzed 10,171 patients aged 65 years or older who had initiated dialysis from 2005 to 2008. MACCE was defined as a composite outcome of all-cause mortality, nonfatal acute myocardial infarction, target vessel revascularization, and nonfatal ischemic and hemorrhagic stroke. The Kaplan-Meier method and Cox proportional hazards model were used, and further comparisons using propensity-score matching at 1:2 ratio were also performed.ResultsA total of 303 elderly patients (3.0%) had dementia at initiating HD. During follow-up, dementia was a significant predictor of MACCE after adjustment for confounding variables. In addition, further analyzed in the propensity-score matched groups, dementia was an independent predictor of both nonfatal ischemic stroke and all-cause mortality.ConclusionsDementia is an independent risk factor for mortality and ischemic stroke in elderly ESRD patients initiating HD. Patients with dementia who start dialysis should be closely monitored to reduce the risk of mortality and ischemic stroke.

Highlights

Dementia is common in end-stage renal disease (ESRD) patients on hemodialysis (HD) and is associated with worse outcomes
Many physicians hesitate to initiate dialysis in elderly patients with dementia because advanced age alone is the most important risk factor of death in ESRD patients [14, 16,17,18]; the benefits of dialysis would be further limited in elderly patients combined with dementia
The early period, within 90 days, after dialysis initiation is regarded as an unstable time because: 1) commonly, the patients were on temporary renal replacement therapy and the best dialysis modality is not yet determined; 2) adverse events during this period are frequently affected by various acute events, rather than by chronic intrinsic morbidities; 3) as a frequent target of comparison, the database for ESRD treatment provided by Medicare in the United States Renal Data System (USRDS) during that period was not readily available

Summary

Introduction

Dementia is common in end-stage renal disease (ESRD) patients on hemodialysis (HD) and is associated with worse outcomes. Dementia is a syndrome affecting memory, thinking and social abilities severely enough to interfere with normal activities of daily living [1] It is the most common mental disorder in the elderly population and a major cause of death and disability among elderly individuals in the. Many physicians hesitate to initiate dialysis in elderly patients with dementia because advanced age alone is the most important risk factor of death in ESRD patients [14, 16,17,18]; the benefits of dialysis would be further limited in elderly patients combined with dementia These patients generally have difficulty to express their treatment-related symptoms. Several studies, including a recent nationwide population-based study in Taiwan, revealed that dementia is strongly and independently associated with morbidity and mortality in the general elderly population and in ESRD patients [8, 10, 22,23,24]

Objectives

Methods

Results

Conclusion