Abstract
There is controversy regarding the extent of risk for dementia in patients with end stage renal disease (ESRD) who are undergoing hemodialysis (HD) or peritoneal dialysis (PD). We examined data from Taiwan's Longitudinal Health Insurance Database, and used Cox proportional hazard regression analysis to compare the development of dementia in 72,934 HD and PD patients with 72,934 matched controls from January 1, 1999 to December 31, 2010. The results indicate an increased risk for dementia overall in HD patients (adjusted hazard ratio [aHR] = 1.64, p < 0.0001) and PD patients (aHR = 2.21, p < 0.0001). HD and PD patients also had significantly greater aHRs for vascular dementia (VaD) and unspecified dementia (UnD), but only HD patients had a significantly greater aHR for Alzheimer's disease (AD). Further research is needed to confirm whether management of ESRD with PD can reduce the incidence of AD, and to identify the mechanisms by which ESRD increases the risk of dementia.
Highlights
Dementia is a major cause of death and disability among elderly individuals in the general population [1], and advanced age, cerebrovascular disease, and cardiovascular risk factors increase the risk for dementia [2]
Cox proportional hazard regression analysis indicated the adjusted hazard ratio (aHR) for dementia was 1.64 (95% confidence interval (CI) = 1.58 to 1.71; p < 0.0001) in HD patients and 2.21 in peritoneal dialysis (PD) patients
The results indicate that end stage renal disease (ESRD) patients undergoing HD or PD have a significantly increased risk for dementia
Summary
Dementia is a major cause of death and disability among elderly individuals in the general population [1], and advanced age, cerebrovascular disease, and cardiovascular risk factors (diabetes, hypertension, hyperlipidemia, and smoking) increase the risk for dementia [2]. The pathogenic mechanisms responsible for the relationship between cognitive decline and kidney dysfunction may be similar to those responsible for relationship between cognitive decline and other cardiovascular disorders, such as atherosclerosis, clinical stroke, silent stroke, oxidative stress, and white matter lesions [6,7,8]. Other pathological conditions, such as www.impactjournals.com/oncotarget neurotoxicity of the uremic state, may explain the relationship of chronic kidney disease (CKD) with cognitive disorders such as Alzheimer’s disease (AD), especially in the absence of obvious cerebrovascular disease [9]. We used the Longitudinal Health Insurance Database (LHIRD) of Taiwan to determine the risk of dementia in ESRD patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) relative to matched healthy controls, and we analyzed the relationships of HD and PD with 3 different dementia subtypes
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