MON-151 THE CURRENT STATUS AND PROGNOSIS OF AGED CHRONIC RENAL PERITONEAL AND HEMODIALYSIS PATEINTS WITH COGNITIVE IMPAIRMENTS

Abstract

Japan is currently moving towards an unprecedented aging society among advanced countries and chronic dialysis patients as well. With aging, psychiatric problems and dementia cases are on the rise, and increasing burden on existing facilities. Our hospital has not only the outpatient department of Internal medicine, but also peritoneal (PD) and hemodialysis (HD) facilities, and Regional Dementia Center. We have accepted chronic dialysis patients, in our medical center and elderly ward, by collaborating with psychiatrists, who are usually unable to maintain hospitalization or outpatient maintenance dialysis unit in other hospitals. Meanwhile we could review the current situation, clarify the current problems and improve so that we can offer more useful medical care in the future. We examined about the clinical findings in our seventeen HD and theirteen PD patients, by MRI, CT, laboratory data, and analysis of the body fluid status, skeletal muscle, lipid; (IN BODYR) was performed. The 17 HD cases (including 8 DM), had the average age: 75.0 ± 8.8 years old, 9 males, 8 females, and mean their dialysis duration was 136 ± 164 months. They were all unmanageable in other hospitals or clinics.The 13 PD cases (including 6 DM), had the average age: 79.9 ± 7.6 years old,10 males, 3 females and mean their dialysis duration was 179± 92 months. About 17 HD cases; there were 11 cases of Alzheimer type dementia, 4 cases of cerebrovascular dementia, and 2 others; mean Hasegawa’s formula expression: 11.5± 8.8, mean BMI: 19.4± 2.2, mean skeletal muscle mass index (SMI): 4.76± 0.9 kg/m2, mean Lipid ratio (%): 23.4± 5.6, mean Z-score points of MRI (assessment of hippocampus atrophy): 2.7± 0.9. Five HD patients with dementia died of asipiration pneumonia and sepsis. About 13 PD cases, there were 5 cases of borderline cerebrovascular dementia, and 8 cases of no dementia; mean Z-score is 0.974± 0.26、mean SMI:6.43± 0.6, mean BMI:22.4± 2.8, mean Lipid ratio: 23.8± 9.6 %. Almost all dialysis patients had several old cerebral infarctions by simple CT examination. Four PD patients changed to HD, because of peritoneal sclerosis, massive pleural effusion, the gangrene of lower limbs and malnutrition. Two PD patients died of sepsis and respiratory failure. Rehabilitation was instructed in all the patients by physiotherapists for the purpose of improving ADL. The 5-year patient survival rate was 58% in HD, and 90% in PD patients. But one-year-patient survival rate of HD patients was about 20% after transferring to our hospital. In our HD patients with dementia, by CT and MRI image findings, there were the special characteristic findings with both Alzheimer-type dementia and cerebrovascular dementia. The hippocampal atrophy of our PD patients was significantly mild as compared with that of HD. There were no obvious dementia cases in PD although 92% of PD patients were over 70 years old and 61 % of PD were over 5-year PD continuation.