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Kidney Week

Abstract: FR-PO906

Association of Dementia Diagnosis at Dialysis Initiation with Mortality in the Elderly ESKD Population in South Korea

Session Information

  • Geriatric Nephrology
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1300 Geriatric Nephrology

Authors

  • Kang, Seongmin, Ulsan University Hospital, Ulsan, Korea (the Republic of)
  • Ye, Byung Min, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
  • Park, Woo Yeong, Keimyung University Dongsan Medical Center, Daegu, Korea (the Republic of)
  • Cho, Jang-Hee, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)
  • Hong, Yu Ah, Catholic University of Korea Daejeon St Mary's Hospital, Daejeon, Korea (the Republic of)
  • Sun, In O, Presbyterian Medical Center, Jeonju, Jeollabuk-do , Korea (the Republic of)
  • Hwang, Won Min, Konyang University Hospital, Daejeon, Korea (the Republic of)
  • Kwon, Soon hyo, Soonchunhyang University Hospital, Yongsan-gu, Seoul, Korea (the Republic of)
  • Yoo, Kyung Don, Ulsan University Hospital, Ulsan, Korea (the Republic of)
  • Kim, Seo Rin, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)

Group or Team Name

  • The Korean Society of Geriatric Nephrology.
Background

Dementia is highly prevalent among patients with end-stage kidney disease (ESKD), with a 2–7 fold increase compared to the general population. However, the clinical implications of dementia have not been sufficiently studied in elderly ESKD patients. Therefore, the aim of this study was to identify elderly ESKD patients with newly started hemodialysis and determine whether the comorbidity with dementia increases mortality.

Methods

The Korean Society of Geriatric Nephrology retrospective cohort includes 2,736 elderly ESKD patients (≥70 years old) who started hemodialysis between 2010 and 2017. Kaplan-Meier survival and Cox regression analyses examined all-cause mortality between patients with and without dementia.

Results

Of the 2406 patients, patients with dementia at the initiation of dialysis were 8.3% (n = 200, Fig. 1), older (79.6±6.0 years old) than patients without dementia (77.7±5.5 years old), and included more women (male:female = 89:111). Pre-ESKD diagnosis of dementia was associated with an increased risk of post-ESKD mortality (HR 1.503; 95% CI, 1.263–1.788; P<0.0001, Fig. 2), and this association remained consistent after multivariate adjustment (HR 1.270; 95% CI, 1.062–1.519; P = 0.009). In the subgroup analysis, prevalent dementia was more closely related to mortality following dialysis initiation in female participants, patients aged 75 to 85, patients with no history of CVA or severe behavior disorder, no nursing home residence, no hospitalization, or short-term hospitalization.

Conclusion

A pre-ESKD diagnosis of dementia was associated with mortality following dialysis initiation in the Korean elderly population. Cognitive assessment at the initiation of dialysis is necessary in the elderly with ESKD, and further studies are needed to compare the prognosis of different treatment options for ESKD in the elderly with dementia.