Abstract
Erythropoietic medications such as including erythropoietin (EPO) are known to be neuroprotective and to correlate with improved cognitive functions. However, it is not known whether supplementation with EPO reduces the risk of dementia in end-stage renal disease (ESRD) patients receiving hemodialysis (HD). Here, we determined whether EPO levels correlate with the incidence of different dementia subtypes, including Alzheimer’s disease (AD), vascular dementia (VaD), and unspecified dementia (UnD), and whether such associations vary with annual cumulatively defined daily doses (DDDs) of EPO for ESRD patients receiving HD. This retrospective study included data from 43,906 adult ESRD patients who received HD between 1999 and 2010. Using hazard ratios and Cox regression models, we found that patients receiving EPO had a 39% lower risk of general dementia than those in the non-EPO group. Similarly, the risks of VaD and UnD was lower for patients in the EPO cohort. The risk of dementia was further reduced in HD patients treated with EPO in combination with iron. Our results suggest that the use of EPO medications in HD patients is associated with a reduced risk of VaD and UnD, but not AD, regardless of whether EPO is used alone or in combination with iron.
Highlights
In maintenance hemodialysis (HD) patients, renal anemia is generally treated with erythropoietic medications, including erythropoietin (EPO) and intravenous iron supplements
The introduction of EPOs has revolutionized the care of anemic patients with chronic kidney disease (CKD) and almost completely eradicated the severe anemia of end-stage renal disease (ESRD) patients
We conducted a total population-based retrospective cohort study to test whether EPO and intravenous iron supplementation correlate with the risk of various dementia subtypes including Alzheimer’s disease (AD), vascular dementia (VaD), and unspecified dementia (UnD) in HD patients
Summary
In maintenance hemodialysis (HD) patients, renal anemia is generally treated with erythropoietic medications, including erythropoietin (EPO) and intravenous iron supplements. Treatment of anemia with EPO was associated with improved neuropsychological test performance and electroencephalography measurements in uncontrolled studies of patients with ESRD conducted in the early 1990s [3, 4]. Due to its protective effects on cognitive function, EPO has been used in the treatment of neuropsychiatric disorders with cognitive impairments, including schizophrenia [6]. The data concerning the effects of EPO and intravenous iron supplementation on specific dementia subtypes among HD patients are scarce. We conducted a total population-based retrospective cohort study to test whether EPO and intravenous iron supplementation correlate with the risk of various dementia subtypes including AD, VaD, and unspecified dementia (UnD) in HD patients
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