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Abstract: PO1385

Patients Who Are Treated for Secondary Hyperparathyroidism Have a Lower Risk of Incident Dementia

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Ahn, JiYoon B., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Mathur, Aarti, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • McAdams-DeMarco, Mara, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Group or Team Name

  • ERGOT
Background

Almost all patients with end-stage kidney disease (ESKD) have secondary hyperparathyroidism (SHPT). Elevated parathyroid hormone has been reported as a potential risk factor of cognitive impairment. We aimed to study whether the risk of dementia is improved when patients on dialysis receive treatment for SHPT.

Methods

Using data from the United States Renal Data System and Medicare claims, we studied older (aged≥66) ESKD patients without known pre-ESKD dementia who initiated maintenance dialysis in 2006-2016. SHPT treatment included vitamin D analogs, phosphate binders, cinacalcet or parathyroidectomy and was treated as a time-dependent treatments in the analysis. The study population was followed until transplant, death, end of Medicare coverage or administrative end date (12/31/2016), whichever came first. We used the Cox regression and adjusted for confounding using the inverse probability weighting method to examine the association of SHPT treatment and incident dementia.

Results

Of 189,433 ESRD patients, 65.1% received a treatment for SHPT during the study period. The rate of incident dementia was 11 per 100 person-years among patients with no SHPT treatment and 6 per 100 person-years among those with an SHPT treatment. Among patients on dialysis, the risk of incident dementia was lower after receiving treatment for SHPT compared with not receiving treatment for SHPT (adjusted hazard ratio=0.600.620.63) after adjusting for confounding.

Conclusion

Receiving treatment for SHPT was associated with a lower risk of incident dementia among older patients with ESKD. SHPT may need to be controlled among older ESKD patients considering the complications of SHPT including cognitive impairment and dementia.

Funding

  • NIDDK Support