Key result
Pre-ESRD dementia was associated with a higher risk of all-cause mortality in the first 6 months after dialysis initiation compared to dementia-free patients (HR 1.25; 95% CI 1.12-1.38).
Why the study?
Does pre-ESRD dementia increase early post-ESRD mortality in patients transitioning to dialysis?
Cohort (n=45,076)
Yes
Does pre-ESRD dementia increase early post-ESRD mortality in patients transitioning to dialysis?
Hazard Ratio: 1.25 (95% CI 1.12–1.38)
Absolute Event Rate: 29.6% vs 18.5%
Pre-ESRD dementia is associated with a 25% increased risk of all-cause mortality within the first 6 months of initiating dialysis in US veterans.
Dementia signals higher mortality risk warranting clinical vigilance; leaves open whether interventions improve survival.
BACKGROUND: Conservative management may be a desirable option for elderly, fragile, or demented patients who reach end-stage renal disease (ESRD), yet some patients with dementia are placed on renal replacement therapy nonetheless. METHODS: From a nationwide cohort of 45,076 US veterans who transitioned to ESRD over 4 contemporary years (October 1, 2007 to September 30, 2011), we identified 1,336 (3.0%) patients with International Classification of Diseases, Ninth Revision, Clinical Modification code-based dementia diagnosis during the prelude (predialysis) period. We examined the association of prelude dementia with all-cause mortality within the first 6 months following transition to dialysis, using a propensity-matched cohort and Cox proportional hazards models. RESULTS: In the entire cohort, the overall mean ± standard deviation age at baseline was 72 ± 11 years, 95% were male, 23% were African-American, and 66% were diabetic. There were 8,080 (18.5%) deaths (mortality rate, 412; 95% confidence interval [CI], 403-421/1,000 patient-years) in the dementia-negative group, and 396 (29.6%) deaths (mortality rate, 708; 95% CI, 642-782/1,000 patient-years) in the dementia-positive group in the entire cohort in the first 6 months after dialysis initiation. Presence of dementia was associated with higher risk of all-cause mortality (adjusted hazard ratio, 1.25; 95% CI, 1.12-1.38) compared to dementia-free patients in the first 6 months after dialysis initiation. CONCLUSION: Pre-ESRD dementia is associated with increased risk of early post-ESRD mortality in veterans transitioning to dialysis.
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Molnar et al. (2017) conducted a cohort in End-stage renal disease (ESRD) (n=45,076). Pre-ESRD dementia vs. Dementia-free patients was evaluated on All-cause mortality within the first 6 months following transition to dialysis (HR 1.25, 95% CI 1.12-1.38). Pre-ESRD dementia was associated with a higher risk of all-cause mortality in the first 6 months after dialysis initiation compared to dementia-free patients (HR 1.25; 95% CI 1.12-1.38).
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