Abstract
Chronic kidney disease (CKD) is associated with dementia. Angiotensin receptor blockers (ARBs) have been widely used for delaying CKD progression; however, their effect on dementia prevention in patients with CKD remains unclear. We designed a retrospective cohort study to investigate the effects of ARBs on the incidence of dementia in patients with CKD. We selected 21,208 patients from the Taiwan nationwide database from 1 January 2006 to 31 December 2006. We identified ARB users (n = 17,466) and ARB non-users (n = 3742) and their medication possession ratio (MPR). The Cox proportional hazard model was used to estimate hazard ratios (HRs) for the incidence of dementia in ARB users in the CKD population. During the 11-year follow-up period, 2207 dementia events were recorded; multivariate-adjusted hazard ratios for dementia by ARB usage and ARB usage per MPR were 0.578 (95% CI: 0.52–0.643) and 0.996 (95% CI: 0.995–0.998), respectively. This association was observed in almost all subgroups. Dose frequency effect of ARBs was noted; patients with higher MPRs of ARBs generally had higher protection from dementia. Patients with hypertension and CKD who received ARBs had a decreased risk of dementia. Protective effects of ARBs on dementia increased with the frequency of ARB use.
Highlights
Chronic kidney disease (CKD), a major health problem that causes considerable financial burden worldwide, can lead to end-stage renal disease (ESRD), resulting in the requirement of renal replacement therapy and contributing to increased cardiovascular mortality and morbidity [1,2]
We examined the correlation between the usage of Angiotensin receptor blockers (ARBs) and the incidence of dementia in the CKD population by using real-world data from the National Health Insurance (NHI) Research Database (NHIRD)
We observed that ARBs exerted a significant protective effect on the incidence of dementia in our hypertensive CKD cohort
Summary
Chronic kidney disease (CKD), a major health problem that causes considerable financial burden worldwide, can lead to end-stage renal disease (ESRD), resulting in the requirement of renal replacement therapy and contributing to increased cardiovascular mortality and morbidity [1,2]. Studies have reported that CKD is an independent risk factor for cognitive impairment and dementia [6,7], which are major health concerns in the older population worldwide [8]. Both the kidneys and brain are highly vascular structures and susceptible to vascular injuries. Patients with CKD might develop vascular dementia [9]. Patients with CKD are prone to develop clinical cerebrovascular diseases such as stroke, transient ischemic attack, and lacunar infarction.
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