Hemodialysis and brain diseases in older individuals

Abstract

AbstractBackgroundIt is known that age‐related brain symptoms (namely gait difficulty and/or dementia/delirium) occur in older individuals under hemodialysis (HD). However, it is not known which types of brain disease underlie such symptoms most.ObjectiveThe aim of this study was to correlate brain symptoms with brain diseases in patients undergoing HD.MethodsThis was a retrospective study at a multi‐faculty university hospital in Japan over a 12‐month period. All subjects were hospital inpatients undergoing HD (either started during hospitalization or maintenance therapy), with a diagnosis of brain symptoms resulting in referral to the neurogeriatric team (dementia/delirium support team, DST).Results(1) More than half our HD patients (n = 133) were ≥ 65 years (mean age, 67 years) and male. (2) 37.6% of them showed brain symptoms and were DST‐referred, among whom 62.4% were > 65 years) (P < 0.05). (3) Of the referred patients, 16% had episodes of fall‐related surgery and 30% had aspiration pneumonia (all older). (4) 23.3% of referred patients needed restraint for the safety of HD (mostly older). (5) Most of the neurological disorders were age‐related brain diseases, for example, most commonly a combination of white matter disease (WMD) and Alzheimer’s disease (AD) (85%, overlap counted), followed by alcoholism and dementia with Lewy bodies (DLB).ConclusionIn HD patients, age‐related brain symptoms (needed restraint for HD, or with recent fall and/or aspiration) increased with age. The most common underlying brain disease seemed to be a combination of WMD and AD.