Outcomes of Dementia Among Dialysis Patients: A Nationwide Population-Based Study in Taiwan 

Authors

  • Hsiu-Chu Shen Departments of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
  • Chih-Chiang Chien Departments of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan
  • Shih-Feng Weng Departments of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
  • Jhi-Joung Wang Departments of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
  • Jinn-Rung Kuo Departments of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan and Institute of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
  • Kao-Chang Lin Departments of Neurology; Holistic Care, Chi-Mei Medical Center, Tainan, Taiwan and Institute of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan

DOI:

https://doi.org/10.12974/2309-6179.2014.01.01.5

Keywords:

Dialysis, elderly, end-stage renal disease, dementia, outcome.

Abstract

Background: High prevalence of cognitive impairment or dementia is associated with end-stage renal disease (ESRD). The risk for dementia and its prognostic significance remain unclear. This study aimed to determine the prevalence, correlations and outcomes of dementia in chronic ESRD dialysis patients. Methods: Using Taiwan National Health Insurance Research Database (NHIRD), we analyzed ESRD patients who received dialysis between 1999 and 2005 to determine the associations between baseline dementia and subsequent outcomes after dialysis. The cumulative survival rate after dialysis was calculated using the Kaplan-Meier method. Cox proportional hazards model was used to identify the risk factors for all-cause mortality. Results: A total 51,238 incident dialysis patients were examined in this study, including 867 patients with dementia. The prevalence of dementia was increasing with age. The proportional rate of dementia in elderly (?75) patients was 10 times higher than that in aged 18~44 years old of baseline. The co-morbidity with cerebrovascular disease was independently associated with dementia in dialysis population. The 1-, 5-, and 9- year cumulative survival rate were 82.1, 32.7, and 16.5% in ESRD patients with dementia, and 93.5, 62.8, and 41.6% in those without dementia (log-rank: p <0.001). ESRD patients with dementia were associated with 53% higher death risk than those without dementia (HR 1.53, 95% CI: 1.40-1.68). Conclusions: Dementia was associated with poor outcome and co-morbidities among ESRD dialysis patients. 

References

Association, A.P., Diagnostic and statistical manual of mental disorders American Psychiatric Association. Washington, dc, 1994. 210.

Knopman, D.S., et al., Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2001. 56(9): p. 1143-53. http://dx.doi.org/10.1212/WNL.56.9.1143

Prince, M., et al., The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement, 2013. 9(1): p. 63-75 e2.

Brookmeyer, R., et al., Survival following a diagnosis of Alzheimer disease. Arch Neurol, 2002. 59(11): p. 1764-7. http://dx.doi.org/10.1001/archneur.59.11.1764

Wolfson, C., et al., A reevaluation of the duration of survival after the onset of dementia. The New England Journal of Medicine, 2001. 344(15): p. 1111-16. http://dx.doi.org/10.1056/NEJM200104123441501

Geneva, The World Health Report 2003—Shaping the future. W.H. Organization, Editor. 2003.

Malone, D.C., et al., Burden of Alzheimer's disease and association with negative health outcomes. Am J Manag Care, 2009. 15(8): p. 481-8.

Natalwala, A., et al., Reasons for hospital admissions in dementia patients in Birmingham, UK, during 2002-2007. Dement Geriatr Cogn Disord, 2008. 26(6): p. 499-505. http://dx.doi.org/10.1159/000171044

Tuppin, P., et al., Primary Health Care Use and Reasons for Hospital Admissions in Dementia Patients in France: Database Study for 2007. Dementia and Geriatric Cognitive Disorders, 2009. 28(3): p. 225-232. http://dx.doi.org/10.1159/000238394

Collins, A.J., et al., 'United States Renal Data System 2011 Annual Data Report: Atlas of chronic kidney disease & endstage renal disease in the United States. Am J Kidney Dis, 2012. 59(1 Suppl 1): p. A7, e1-420.

Xue, J.L., et al., Forecast of the number of patients with endstage renal disease in the United States to the year 2010. J Am Soc Nephrol, 2001. 12(12): p. 2753-8.

Kurella, M., et al., Cognitive impairment in chronic kidney disease. J Am Geriatr Soc, 2004. 52(11): p. 1863-9. http://dx.doi.org/10.1111/j.1532-5415.2004.52508.x

Murray, A.M., et al., Cognitive impairment in hemodialysis patients is common. Neurology, 2006. 67(2): p. 216-23. http://dx.doi.org/10.1212/01.wnl.0000225182.15532.40

Sehgal, A.R., et al., Prevalence, recognition, and implications of mental impairment among hemodialysis patients. Am J Kidney Dis, 1997. 30(1): p. 41-9. http://dx.doi.org/10.1016/S0272-6386(97)90563-1

Collins, A.J., et al., Excerpts from the United States Renal Data System 2006 Annual Data Report. Am J Kidney Dis, 2007. 49(1 Suppl 1): p. A6-7, S1-296.

Kurella, M., et al., Correlates and outcomes of dementia among dialysis patients: the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant, 2006. 21(9): p. 2543-8. http://dx.doi.org/10.1093/ndt/gfl275

Rakowski, D.A., et al., Dementia as a predictor of mortality in dialysis patients. Clin J Am Soc Nephrol, 2006. 1(5): p. 1000- 5. http://dx.doi.org/10.2215/CJN.00470705

Knopman, D., et al., Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology, 2001. 56(1): p. 42- 8. http://dx.doi.org/10.1212/WNL.56.1.42

Longenecker, J.C., Traditional Cardiovascular Disease Risk Factors in Dialysis Patients Compared with the General Population: The CHOICE Study. Journal of the American Society of Nephrology, 2002. 13(7): p. 1918-1927. http://dx.doi.org/10.1097/01.ASN.0000019641.41496.1E

Murray, A.M., Cognitive Impairement in the Aging Dialysis and Chronic Kidney Disease Population: an Occult Burden. Adv Chronic Kidney Dis, 2008, April 15(2): p. 123-132. http://dx.doi.org/10.1053/j.ackd.2008.01.010

Griva, K., et al., Cognitive impairment and 7-year mortality in dialysis patients. Am J Kidney Dis, 2010. 56(4): p. 693-703. http://dx.doi.org/10.1053/j.ajkd.2010.07.003

Murray, A.M., Cognitive impairment in the aging dialysis and chronic kidney disease populations: an occult burden. Adv Chronic Kidney Dis, 2008. 15(2): p. 123-32. http://dx.doi.org/10.1053/j.ackd.2008.01.010

Cohen, L.M., et al., Renal palliative care. J Palliat Med, 2006. 9(4): p. 977-92. http://dx.doi.org/10.1089/jpm.2006.9.977

Downloads

Published

2014-02-05

How to Cite

Shen, H.-C., Chien, C.-C., Weng, S.-F., Wang, J.-J., Kuo, J.-R., & Lin, K.-C. (2014). Outcomes of Dementia Among Dialysis Patients: A Nationwide Population-Based Study in Taiwan . Journal of Neurology and Epidemiology, 2(1), 30–37. https://doi.org/10.12974/2309-6179.2014.01.01.5

Issue

Section

Articles