High rates of dementia in older adults after starting dialysis

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.

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Materials provided by American Society of Nephrology. Note: Content may be edited for style and length.