Pre-ESRD dementia and post-ESRD mortality in advanced CKD patients transitioning to dialysis

Abstract

INTRODUCTION AND AIMS: Dementia is very frequently seen in elderly populations, which make up the majority of incident dialysis patients. There is increasing evidence suggesting that conservative treatment is a viable option for elderly, fragile, or demented patients compared to dialysis therapy. However, there is a paucity of evidence on the association between the presence of dementia in patients with advanced non-dialysis dependent chronic kidney disease (NDD-CKD) and postend stage renal disease (ESRD) mortality, particularly among those in the transition period from late-stage NDD-CKD to maintenance dialysis. METHOD(S): From a nation-wide cohort of 45,076 US veterans who transitioned to ESRD over 4 contemporary years (10/2007-09/2011), we identified 1,336 (3%) patients with a dementia diagnosis during the prelude (pre-dialysis) period according to inpatient and outpatient ICD-9-CM codes (290.x, 294.1x, 331.2x). We examined the association of prelude dementia with all-cause mortality within the first 6 months of transition to dialysis, using a propensity-matched cohort and Cox proportional hazards models. RESULT(S): The overall mean+/-SD age at baseline was 77+/-9 years; 95% were male; 24% were African-American; and 71% were diabetic in the propensity-matched cohort. There were 340 deaths (25.6%, mortality rate 599 [538-666]/1000 patient-years) in the dementia negative group, and 396 deaths (29.8%, 714 [645-787]/1000 patient-years) in the dementia positive group in the propensity-matched cohort. Presence of dementia was associated with higher risk of all-cause mortality (hazard ratio: 1.19, 95% confidence interval: 1.03-1.37) compared to dementia free patients in the first 6 months after dialysis initiation. Similar results were found most subgroups. CONCLUSION(S): Pre-ESRD dementia is associated with increased risk of early post- ESRD mortality in veterans transitioning to dialysis. Clinical studies are warranted to compare survival and quality of life of dialysis treatment versus conservative treatment in patients with dementia. (Table Presented).