Kidney Week

Abstract: SA-PO1143

Impact of Conservative Management vs. Dialysis Transition on Cognition in a National Cohort of Patients with Advanced CKD

Session Information

• CKD: Progression, Drugs, Modalities, and Environmental Factors
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

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

Seungsook You, MS

• Nguyen, Danh V., University of California Irvine, Irvine, California, United States

Danh V. Nguyen, PhD

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

Yaara Zisman-Ilani, MA, PhD

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

Csaba P. Kovesdy, MD, FASN

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

Susan T. Crowley, MD, MBA, FASN

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

Dana B. Mukamel

• Novoa Vargas, Alejandra, University of California Los Angeles, Los Angeles, California, United States

Alejandra Novoa Vargas, MPH

• 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

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

Connie Rhee, MD, MS

Background

Dialysis has been the prevailing treatment paradigm in advanced CKD patients progressing to ESKD, but may lead to impaired physical function and HRQOL in certain subgroups. We compared the impact of conservative management (CM) vs. dialysis on cognitive function in a national advanced CKD cohort.

Methods

We examined advanced CKD patients (≥2 eGFRs <25 separated by ≥90 days) treated with CM vs. dialysis (non-receipt vs. receipt of dialysis within 2-yrs of 1^st eGFR <25) over 1/1/07-6/30/20 from the OptumLabs^® Data Warehouse, which contains de-identified administrative claims, including medical/pharmacy claims and enrollment records for commercial/Medicare Advantage enrollees, and EHR data. We compared risk of incident dementia, mild cognitive impairment (MCI), and combined dementia/MCI ascertained by diagnostic codes in CM vs. dialysis patients matched by propensity score (PS) to address confounding by indication in unadjusted and doubly-adjusted Cox models. We also examined Fine-Gray subdistribution hazard models and cumulative incidence curves to account for death as a competing risk.

Results

In 18,383 CM patients PS-matched to 18,383 dialysis patients, unadjusted Cox models showed dialysis transition was associated with higher risk of dementia, MCI, or combined dementia/MCI vs. CM: HRs (95%CIs) 1.40 (1.32-1.48), 1.64 (1.46, 1.85), and 1.42 (1.34, 1.49). Findings were robust in analyses doubly-adjusted for PS covariates (Fig 1A). Fine-Gray competing risk analyses showed dialysis was linked with higher risk of idementia, MCI, or combined dementia/MCI (ref: CM): SHRs (95%CIs) 1.32 (1.24, 1.39), 1.51 (1.34, 1.70), and 1.34 (1.27, 1.41). Cumulative incidence curves showed higher incident dementia risk with dialysis transition vs. CM (Fig 1B).

Conclusion

In a national advanced CKD cohort, dialysis transition was associated with a higher dementia/MCI risk vs. CM. Further research is needed to identify strategies that mitigate cognitive decline in advanced CKD patients transitioning to dialysis.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025384tq669