Abstract: SA-OR031

Dementia and Alzheimer’s Disease Among Older Adults Initiating Hemodialysis

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • McAdams-DeMarco, Mara, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Daubresse, Matthew, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Bae, Sunjae, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
Background

Older end-stage renal disease (ESRD) patients experience rapid declines in executive function after initiating hemodialysis; these impairments might lead to high rates of dementia and Alzheimer’s disease (AD) in this population. We estimated incidence, risk factors, and sequelae of dementia and AD among older ESRD patients initiating hemodialysis.

Methods

We studied 356,668 older (age≥66) hemodialysis patients (1/1/2001-12/31/2013) from national registry data [United States Renal Data System] linked to Medicare. We estimated dementia and AD risk (cumulative incidence), studied factors associated with these disorders using competing risks models, and estimated the risk of subsequent mortality using Cox proportional hazards models.

Results

The 1-year, 10-year, and lifetime dementia risks were 4.6%, 22.1%, 25.1% for women and 3.7%, 18.9%, and 21.3% for men. The corresponding AD risks were 0.6%, 4.3%, and 5.4% for women and 0.4%, 3.4%, and 4.2% for men. The strongest independent risk factors for dementia and AD were age≥86 years (dementia: HR=2.11, 95%CI:1.99-2.23; AD: HR=2.33, 95%CI:2.06-2.63), African American race (dementia: HR=1.70, 95%CI:1.64-1.75; AD: HR=1.92, 95%CI:1.79-2.06), and institutionalization (dementia: HR=1.50, 95%CI:1.41-1.59; AD: HR=1.49, 95%CI:1.31-1.69). Older HD patients with dementia were at 2.17-fold (95%CI:2.15-2.19) increased risk of subsequent mortality; those with AD were at 1.92-fold (95%CI:1.88-1.95) increased mortality risk.

Conclusion

Older hemodialysis patients are at substantial risk of dementia and AD, and these disorders increase subsequent mortality risk 2-fold. Hemodialysis may be inadequate to treat ESRD patients; the role of renal replacement therapy, particularly in older adults, should be expanded to protect cognitive function.

Cumulative Incidence of Dementia After Hemodialysis Initiation

Funding

  • Other NIH Support