Study Reveals High Rates of Dementia in Older Adults after Starting Dialysis

Article ID: 698522

Released: 3-Aug-2018 9:00 AM EDT

Source Newsroom: American Society of Nephrology (ASN)

Highlights

  • Older adults who initiate dialysis for kidney failure face a higher likelihood of being diagnosed with dementia and Alzheimer’s disease.
  • Certain risk factors were linked this higher risk.
  • Older hemodialysis patients with a diagnosis of dementia or Alzheimer’s disease had a high risk of early death.

Newswise — Washington, DC (August 9, 2018) — New research has uncovered a higher rate of dementia in older adults after the initiation of hemodialysis. The study, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), also found that dementia in dialysis patients is linked with a higher risk of early death. 

Older patients on hemodialysis often experience a significant decline in cognitive function while undergoing hemodialysis, which puts them at high risk for developing dementia. To examine the issue, Mara McAdams-DeMarco, PhD (Johns Hopkins Bloomberg School of Public Health) and her colleagues analyzed information on 356,668 US hemodialysis patients aged ≥66 years.

The 1- and 5-year risks of being diagnosed with dementia after initiating hemodialysis were 4.6% and 16% for women and 3.7% and 13% for men. The respective risks of being diagnosed with Alzheimer’s disease were 0.6% and 2.6% for women and 0.4% and 2.0% for men.

Previous research suggests that the 10-year incidence of dementia is 1.0-1.5% in adults aged 65 years and 7.4-7.6% in adults aged 75 years. Using a similar analytic approach, Dr. McAdams-DeMarco and her team estimated that the 10-year risk of a post-hemodialysis dementia diagnosis is 19% for patients aged 66-70 years, rising to 28% for those 76-80 years.

The strongest risk factors for dementia and Alzheimer’s disease were age ≥86 years, Black race, female sex, and institutionalization (such as in a nursing home). Also, older hemodialysis patients with a diagnosis of dementia or Alzheimer’s disease had a 2-fold higher risk of dying.

“We wanted to shed light on the high burden of diagnosed dementia in older patients with kidney failure who initiate hemodialysis,” said Dr. McAdams-DeMarco. “While we were able to study diagnosed dementia, there is a great need to also identify patients with mild cognitive impairment as well as undiagnosed dementia.”

In an accompanying Patient Voice editorial, Judy Weintraub of Los Angeles provides her perspective as a dialysis patient and chaplaincy candidate. She notes the need to emphasize a culture of respect and dignity for all, regardless of physical and cognitive abilities. Her recommendations for dialysis facilities include encouraging a sense of community, introducing music, and communicating with patients. “This is a call for facility administrators and medical directors to institute policies from the top down to foster a shift in the way care is delivered,” she wrote. “Let’s institute in our policies and procedures not just what care is delivered, but how that care is delivered.”

Study co-authors include Matthew Daubresse, MHS, Sunjae Bae KMD, MPH, Alden Gross, PhD, Michelle Carlson, PhD, and Dorry Segev, MD, PhD.

Disclosures: This work was supported by the National Institutes of Health. The authors reported no financial disclosures.

The article, entitled “Dementia, Alzheimer’s Disease, and Mortality After Hemodialysis Initiation,” will appear online at http://cjasn.asnjournals.org/ on August 9, 2018, doi: 10.2215/CJN.10150917. 

The accompanying editorial, entitled “Dementia in Dialysis,” will appear online at http://cjasn.asnjournals.org/ on August 9, 2018.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has more than 18,000 members representing 112 countries. For more information, please visit www.asn-online.org or contact the society at 202-640-4660.

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