Risk of dementia in peritoneal dialysis patients compared with hemodialysis patients. Perit Dial Int 2015;35(2):189-98
Date
03/07/2015Pubmed ID
25742686Pubmed Central ID
PMC4406314DOI
10.3747/pdi.2014.00213Scopus ID
2-s2.0-84930918540 (requires institutional sign-in at Scopus site) 48 CitationsAbstract
BACKGROUND: Compared with similarly aged controls, patients with end-stage renal disease (ESRD) have a higher prevalence of cognitive impairment and more rapid cognitive decline, which is not explained by traditional risk factors alone. Since previous small studies suggest an association of cognitive impairment with dialysis modality, we compared incident dementia among patients initiating hemodialysis (HD) vs peritoneal dialysis (PD) in a large national cohort.
METHODS: This is a retrospective cohort study of incident dialysis patients in the United States from 2006 to 2008 with no diagnosis of dementia prior to beginning dialysis. We evaluated the effect of initial dialysis modality on incidence of dementia, diagnosed by Medicare claims data, adjusted for baseline demographic and clinical data from the USRDS registry.
RESULTS: Our analysis included 121,623 patients, of whom 8,663 initiated dialysis on PD. The mean age of our cohort was 69.2 years. Patients who initiated PD had a lower cumulative incidence of dementia than those who initiated HD (1.0% vs 2.7%, 2.5% vs 5.3%, and 3.9% vs 7.3% at 1, 2, and 3 years, respectively). The risk of dementia for patients who started on PD was lower compared with those who started on HD, with a hazard ratio (HR) = 0.46 [0.41, 0.53], in an unadjusted model and HR 0.74 [0.64, 0.86] in a matched model.
CONCLUSIONS: Dialysis modality is associated with incident dementia in a cohort of older ESRD patients. This finding warrants further investigation of the effect of dialysis modality on cognitive function and evaluation for possible mechanisms.
Author List
Wolfgram DF, Szabo A, Murray AM, Whittle JAuthors
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of WisconsinDawn Felicity Wolfgram MD Associate Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Child
Child, Preschool
Dementia
Female
Humans
Incidence
Infant
Infant, Newborn
Kidney Failure, Chronic
Male
Middle Aged
Peritoneal Dialysis
Retrospective Studies
Risk Factors
United States
Young Adult
