Delirium is independently associated with early mortality in elderly patients starting hemodialysis

Arai, Yohei; Shioji, Shingo; Tanaka, Hiroyuki; Kondô, Isao; Sakamoto, Emi; Suzuki, Minami; Katagiri, Daisuke; Tada, Manami; Hinoshita, Fumihiko

doi:10.1007/s10157-020-01941-5

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…Our study results are in accordance with reports showing that HD is prevalent in older individuals who have CKD or other renal diseases, 1,2 and that age‐related complications, particularly neurological complications, are common in such patients 5,6 . It is known that brain diseases cause gait difficulty/fall/aspiration, dementia/delirium, or both.…”

Section: Discussionsupporting

confidence: 92%

“…Our study results are in accordance with reports showing that HD is prevalent in older individuals who have CKD or other renal diseases, 1,2 and that age-related complications, particularly neurological complications, are common in such patients. 5,6 It is known that brain diseases cause gait difficulty/fall/aspiration, dementia/ delirium, or both. Among these, gait 3 and aspiration 4 disorders are typically caused by lesions in the pyramidal and extrapyramidal pathways in the brain, respectively; the frontal cortex and supplemental motor area are also relevant.…”

Section: 2 | Age-related Brain Symptoms and Brain Diseases In Hd Pati...mentioning

confidence: 99%

“…It is known that older individuals under HD frequently have age‐related brain symptoms, namely parkinsonism with/without sarcopenia (gait difficulty and fall, 3 aspiration, 4 etc.) and cognitive decline (delirium 5 /dementia 6 ). In contrast, it is not known which types of brain disease most commonly underlie such symptoms; CKD can occur in parallel with brain diseases such as Alzheimer’s disease (AD), 7 white matter disease (WMD, also called small vessel disease), 8 dementia with Lewy bodies (DLB, related to Parkinson’s disease), and alcoholism.…”

Section: Introductionmentioning

confidence: 99%

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Hemodialysis and brain diseases in older individuals

Iimura

Sakakibara

Sawai

et al. 2022

Neurology & Clinical Neurosc

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Background: It is known that age-related brain symptoms (namely gait difficulty and/ or dementia/delirium) occur in older individuals under hemodialysis (HD). However, it is not known which types of brain disease underlie such symptoms most. Objective:The aim of this study was to correlate brain symptoms with brain diseases in patients undergoing HD. Methods:This was a retrospective study at a multi-faculty university hospital in Japan over a 12-month period. All subjects were hospital inpatients undergoing HD (either started during hospitalization or maintenance therapy), with a diagnosis of brain symptoms resulting in referral to the neurogeriatric team (dementia/delirium support team, DST). Results:(1) More than half our HD patients (n = 133) were ≥ 65 years (mean age, 67 years) and male. (2) 37.6% of them showed brain symptoms and were DST-referred, among whom 62.4% were > 65 years) (P < 0.05). (3) Of the referred patients, 16% had episodes of fall-related surgery and 30% had aspiration pneumonia (all older). ( 4) 23.3% of referred patients needed restraint for the safety of HD (mostly older). ( 5) Most of the neurological disorders were age-related brain diseases, for example, most commonly a combination of white matter disease (WMD) and Alzheimer's disease (AD) (85%, overlap counted), followed by alcoholism and dementia with Lewy bodies (DLB). Conclusion:In HD patients, age-related brain symptoms (needed restraint for HD, or with recent fall and/or aspiration) increased with age. The most common underlying brain disease seemed to be a combination of WMD and AD.

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Section: Discussionsupporting

confidence: 92%

Section: 2 | Age-related Brain Symptoms and Brain Diseases In Hd Pati...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hemodialysis and brain diseases in older individuals

Iimura

Sakakibara

Sawai

et al. 2022

Neurology & Clinical Neurosc

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“…Moreover, studies suggest that this disorder is more prevalent among elderly patients [65,105]. A recent study found that delirium is independently associated with early mortality in the elderly after starting hemodialysis [106]. The acute delirium could lead to self-harm and death [107].…”

Section: Deliriummentioning

confidence: 99%

Psychosocial Aspects in Hemodialysis

Almutary¹

2023

Updates on Hemodialysis

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Several psychosocial stressors have an impact on patients with end-stage kidney disease (ESKD). The disease and its treatment modalities impose several lifestyle changes. These include the impact of disease and treatment, dietary and fluid restrictions, functional limitations and sexual dysfunction, and future uncertainty and fear of death. Furthermore, family and social issues such as changes in family roles and changes in duties and responsibilities may add to psychosocial stressors among people on dialysis. Commonly associated psychosocial issues include depression, anxiety, delirium, withdrawal, and decreased quality of life. The prevalence and severity of each psychological issue vary, and there are several tools available to detect these issues. This chapter will focus on the most common psychosocial stressors among people with hemodialysis.

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A Novel Uremic Score Reflecting Accumulation of Specific Uremic Toxins More Precisely Predicts One-Year Mortality after Hemodialysis Commencement: A Retrospective Cohort Study

Arai

Shioji

Tanaka

et al. 2020

Toxins

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Uremic toxins (UTs) generally accumulate in patients developing end-stage renal disease (ESRD). Although some kinds of UTs cause early death after starting hemodialysis (HD), it remains unknown whether the degree of excessive accumulation of various UTs is associated with worsening of prognosis. We retrospectively conducted this cohort study consisting of adult patients developing ESRD who initiated HD at the National Center for Global Health and Medicine from 2010 to 2019. We created a new uremic score, which was defined as the aggregate score of the following variables reflecting uremic state: elevated blood urea nitrogen, β2-microglobulin, and anion gap before starting HD. The primary outcome was early mortality within 1-year after HD commencement. The hazard ratio (HR) and 95% confidence interval (CI) for a one-point increase in uremic score was calculated with Cox proportional hazard models adjusted by baseline conditions. We included 230 participants, 16 of whom experienced the primary outcome of early mortality after HD commencement. Uremic score was significantly associated with the primary outcome (crude HR: 1.91, 95% CI 1.16–3.14; adjusted HR: 4.19, 95% CI 1.79–9.78). Our novel uremic score, reflecting accumulation of specific UTs, more precisely predicts early mortality after HD commencement.

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Delirium is independently associated with early mortality in elderly patients starting hemodialysis

Cited by 3 publications

References 23 publications

Hemodialysis and brain diseases in older individuals

Hemodialysis and brain diseases in older individuals

Psychosocial Aspects in Hemodialysis

A Novel Uremic Score Reflecting Accumulation of Specific Uremic Toxins More Precisely Predicts One-Year Mortality after Hemodialysis Commencement: A Retrospective Cohort Study

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