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Abstract: TH-PO659

Anemia and Dementia Risk in US Veterans With New-Onset CKD

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Koyama, Alain, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Yu, Wei, University of Virginia, Charlottesville, Virginia, United States
  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Choudhury, Devasmita, University of Virginia, Charlottesville, Virginia, United States
  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States
  • Norris, Keith C., University of California Los Angeles, Los Angeles, California, United States
  • Cho, Monique E., University of Utah Health, Salt Lake City, Utah, United States
  • Yan, Guofen, University of Virginia, Charlottesville, Virginia, United States
Background

Current evidence suggests anemia is a risk factor for dementia. Older adults with chronic kidney disease CKD are at increased risk of both anemia and dementia; however, it is unclear how CKD influences the association between these two conditions. We examined the association between anemia and risk of dementia in US veterans with new-onset CKD.

Methods

The cohort included 444,474 veterans, aged ≥65 years, with new-onset CKD (estimated GFR<60 mL/min/1.73 m2 for >3 months) in 2005-2016 in the Veterans Health Administration (VHA), followed for 2-14 years. At baseline, veterans were free of dementia and end-stage kidney disease. The severity of anemia was determined using baseline hemoglobin with pre-defined thresholds (g/dL): moderate or severe, <11.0; mild, 11.0-11.9; and none ≥12.0 for women; and <11.0, 11.0-12.9, and ≥13.0 for men, respectively. The outcome was incident dementia over follow-up identified using ICD-9/10 codes in claims from the VHA and Centers for Medicare & Medicaid Services. We estimated unadjusted and adjusted risks of dementia using cause-specific hazard ratios to account for the competing risk of death.

Results

The cohort had a mean±SD age of 76.3±7.2 years, and 98% were men. At baseline, 22,329 (5%), 114,314 (26%), and 307,831 (69%) veterans had moderate or severe anemia, mild anemia, and no anemia, respectively. Dementia incidence per 1,000 person-years was 52.7, 46.1, and 35.9 cases for patients with moderate or severe, mild, and no anemia, respectively. After multivariable adjustment, compared to patients without anemia, those with moderate or severe anemia had a 23% significant increased risk of dementia, while those with mild anemia had a 12% significant increased risk (Table).

Conclusion

Among patients with incident CKD, anemia was independently associated with an increased risk of dementia.

Dementia risk by anemia status among veterans with incident CKD
 Incidence of dementia (per 1000 patient-years)Unadjusted hazard ratio (95% CI)Adjusted hazard ratio (95% CI)*
No anemia35.91.00 (reference)1.00 (reference)
Mild anemia46.11.35 (1.32-1.37)1.12 (1.10-1.14)
Moderate or severe anemia52.71.60 (1.55-1.65)1.23 (1.19-1.27)

*adjusted for demographics and baseline clinical characteristics (eGFR, erythropoietin-stimulating agent use, body mass index, systolic and diastolic blood pressure, smoking status, and a wide range of prevalent comorbidities)