Kidney Week

Abstract: SA-PO0347

Conservative Management vs. Dialysis and Cognitive Function in Veterans with Advanced CKD Using Competing Risks Approaches

Session Information

• Dialysis: Epidemiology and Facility Management
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Narasaki, Yoko, University of California Los Angeles, Los Angeles, California, United States

Yoko Narasaki, MS, PhD

• Kalantar-Zadeh, Kamyar, The Lundquist Institute, Torrance, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Zisman-Ilani, Yaara, Temple University, Philadelphia, Pennsylvania, United States

Yaara Zisman-Ilani, MA, PhD

• Crowley, Susan T., Yale University, New Haven, Connecticut, United States

Susan T. Crowley, MD, MBA, FASN

• Kovesdy, Csaba P., The University of Tennessee Health Science Center Department of Medicine, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

• Mukamel, Dana B., University of California Irvine, Irvine, California, United States

Dana B. Mukamel

• Lee, Cathy C, University of California Los Angeles, Los Angeles, California, United States

Cathy C Lee, MD, MS

• Wilkins, Stacy Schantz, University of California Los Angeles, Los Angeles, California, United States

Stacy Schantz Wilkins, PhD

• Li, Zhaoping, University of California Los Angeles, Los Angeles, California, United States

Zhaoping Li

• Ong, Michael K, University of California Los Angeles, Los Angeles, California, United States

Michael K Ong, MD, PhD

• You, Seungsook, University of California Los Angeles, Los Angeles, California, United States

Seungsook You, MS

• Nguyen, Danh V., University of California Los Angeles, Los Angeles, California, United States

Danh V. Nguyen, PhD

• Rhee, Connie, University of California Los Angeles, Los Angeles, California, United States

Connie Rhee, MD, MS

Background

While dialysis has been the dominant treatment paradigm in advanced CKD patients progressing to ESKD, there is growing interest in conservative management (CM) as an alternative patient-centered treatment strategy for advanced CKD in certain subgroups (elderly, multi-morbid). We examined the association of CM vs. dialysis transition with cognitive dysfunction in Veterans with advanced CKD.

Methods

Using linked national VA, USRDS, and Medicare data, we examined Veterans with advanced CKD (≥2 eGFRs <25 separated by ≥90 days) categorized according to receipt of CM, defined as those who did not receive dialysis within 2-yrs of the index eGFR (1^st eGFR <25), vs. receipt of dialysis within 2-yrs of the index eGFR. We compared the risk of incident dementia, mild cognitive impairment (MCI), and either dementia or MCI (combined dementa/MCI) ascertained by diagnostic codes in CM vs. dialysis patients matched by propensity score (PS) in a 1:1 ratio to address confounding by indication using unadjusted and doubly-adjusted Fine-Gray subdistribution hazard models to account for all-cause death as a competing risk.

Results

Among 90,017 patients who met eligibility criteria, there were 15,844, 3406, and 16,858 patients who developed dementia, MCI, and combined dementia/MCI, respectively. In the unadjusted PS-matched models, transition to dialysis was associated with higher risk of incident dementia, MCI, or combined dementia/MCI compared to CM: SHRs (95%CIs) 1.36 (1.28-1.45), 1.34 (1.18-1.52), and 1.32 (1.24-1.40), respectively. Similar findings were observed in sensitivity analyses doubly-adjusted for PS covariates.

Conclusion

In a national cohort of US Veterans, transition to dialysis was associated with higher risk of dementia and MCI compared to CM in analyses that accounted for death as a competing risk. Further studies are needed to determine the mechanistic pathways underlying the differential risk of cognitive dysfunction across advanced CKD treatment strategies.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20255jjfnh8z