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Abstract: FR-PO428

An Analysis of Delirium in Elderly Patients with ESRD During Hospitalization for Starting Maintenance Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Arai, Yohei, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Tanaka, Hiroyuki, Yokosuka Kyosai Hospital, Yokosuka-shi, Kanagawa, Japan
  • Shioji, Shingo, Yokosuka Kyosai Hospital, Yokosuka-shi, Kanagawa, Japan
  • Kondo, Isao, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Sakamoto, Emi, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Suzuki, Minami, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Katagiri, Daisuke, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Tada, Manami, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
  • Hinoshita, Fumihiko, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
Background

Delirium is an acute and usually reversible disturbance in mental abilities that causes confused thinking and emotional disruption. It has recently been reported that delirium is an independent predictor of death in patients undergoing maintenance dialysis for end-stage renal disease (ESRD). Although it is well known that delirium occurs much more easily in the elderly, it remains unproved whether the occurrence of delirium during hospitalization for starting dialysis is associated with early mortality after the start of dialysis in elderly populations.

Methods

We conducted a retrospective cohort study to investigate the association between delirium and early mortality after starting dialysis in the elderly. The cohort consisted of patients aged 75 years old or older who started hemodialysis for ESRD at the National Center for Global Health and Medicine from 2010 to 2017 and at Yokosuka Kyosai Hospital from 2007 to 2011. Delirium was defined as patients who, during hospitalization for starting dialysis, newly showed confused thinking and reduced awareness of their environment and were prescribed anti-psychotic medications. The primary outcome was death within a year of the start of dialysis. Data were analyzed using Cox proportional hazard models with adjustments for baseline characteristics. To assess underlying characteristics of the patients with delirium, we identified the determinants using a multinomial logistic regression.

Results

We enrolled 264 patients (males, 59%); 34 patients were diagnosed with delirium. The primary outcome was observed in 19 patients with delirium (55%) and 26 patients without delirium (11%) (p < 0.01). In a Cox proportional hazards model, delirium was independently associated with a higher risk of all-cause mortality within a year of the start of dialysis (hazard ratio 6.96, 95% confidence interval 3.84-12.63; adjusted hazard ratio 5.78, 95% confidence interval 2.93-11.41). In a multinomial logistic regression, delirium was positively correlated with “cognitive impairment” and “the use of steroid” and inversely correlated with “the presence of arteriovenous fistula”.

Conclusion

Delirium predicts early mortality after starting dialysis in the elderly.