Association between dementia diagnosis at dialysis initiation and mortality in older patients with end-stage kidney disease in South Korea
10.23876/j.krcp.23.151
- Author:
Byung Min YE
;
Seongmin KANG
;
Woo Yeong PARK
;
Jang-Hee CHO
;
Byung Chul YU
;
Miyeun HAN
;
Sang Heon SONG
;
Gang-Jee KO
;
Jae Won YANG
;
Sungjin CHUNG
;
Yu Ah HONG
;
Young Youl HYUN
;
Eunjin BAE
;
In O SUN
;
Hyunsuk KIM
;
Won Min HWANG
;
Sung Joon SHIN
;
Soon Hyo KWON
;
Seo Rin KIM
;
Kyung Don YOO
;
- Publication Type:Original Article
- From:Kidney Research and Clinical Practice
2025;44(2):277-287
- CountryRepublic of Korea
- Language:English
-
Abstract:
The prevalence of dementia is 2- to 7-fold higher among patients with end-stage kidney disease (ESKD) than among the general population; however, its clinical implications in this population remain unclear. Therefore, this study aimed to determine whether comorbid dementia increases mortality among older patients with ESKD undergoing newly initiated hemodialysis. Methods: We analyzed data from the Korean Society of Geriatric Nephrology retrospective cohort, which included 2,736 older ESKD patients (≥70 years old) who started hemodialysis between 2010 and 2017. Kaplan-Meier survival and Cox regression analyses were used to examine all-cause mortality between the patients with and without dementia in this cohort. Results: Of the 2,406 included patients, 8.3% had dementia at the initiation of dialysis; these patients were older (79.6 ± 6.0 years) than patients without dementia (77.7 ± 5.5 years) and included more women (male:female, 89:111). Pre-ESKD diagnosis of dementia was associated with an increased risk of overall mortality (hazard ratio, 1.503; p < 0.001), and this association remained consistent after multivariate adjustment (hazard ratio, 1.268; p = 0.009). In subgroup analysis, prevalent dementia was associated with mortality following dialysis initiation in female patients, those aged <85 years, those with no history of cerebrovascular accidents or severe behavioral disorders, those not residing in nursing facilities, and those with no or short-term hospitalization. Conclusion: A pre-ESKD diagnosis of dementia is associated with mortality following dialysis initiation in older Korean population. In older patients with ESKD, cognitive assessment at dialysis initiation is necessary.
