Dementia is a risk factor for major adverse cardiac and cerebrovascular events in elderly Korean patients initiating hemodialysis: a Korean national population-based study

Abstract

BackgroundDementia is common in end-stage renal disease (ESRD) patients on hemodialysis (HD) and is associated with worse outcomes. This study aimed to investigate the risk of major adverse cardiac and cerebrovascular event (MACCE) in elderly patients with dementia initiating HD.MethodsUsing the database from the Health Insurance Review & Assessment Service, we analyzed 10,171 patients aged 65 years or older who had initiated dialysis from 2005 to 2008. MACCE was defined as a composite outcome of all-cause mortality, nonfatal acute myocardial infarction, target vessel revascularization, and nonfatal ischemic and hemorrhagic stroke. The Kaplan-Meier method and Cox proportional hazards model were used, and further comparisons using propensity-score matching at 1:2 ratio were also performed.ResultsA total of 303 elderly patients (3.0%) had dementia at initiating HD. During follow-up, dementia was a significant predictor of MACCE after adjustment for confounding variables. In addition, further analyzed in the propensity-score matched groups, dementia was an independent predictor of both nonfatal ischemic stroke and all-cause mortality.ConclusionsDementia is an independent risk factor for mortality and ischemic stroke in elderly ESRD patients initiating HD. Patients with dementia who start dialysis should be closely monitored to reduce the risk of mortality and ischemic stroke.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0547-0) contains supplementary material, which is available to authorized users.

Association between dementia diagnosis at dialysis initiation and mortality in older patients with end-stage kidney disease in South Korea

“…These findings are consistent with those of recent studies, which reported that the presence of dementia before dialysis increased the risk of postdialysis mortality by 19% to 30% [18,19]. Multiple factors, such as increased cardiac and cerebrovascular risks [19], frailty [14,20], impeding treatment adherence [21], and comorbidities [22], may contribute to post-ESKD mortality in dementia. Interestingly, dementia in the subgroup with comorbid CVA or severe behavioral disorders was not significantly associ-…”

“…Although the severity of dementia was not investigated in this study, it is surprising that more than 8% of patients with ESKD exhibit dementia at the time of hemodialysis initiation in South Korea. A previous study based on the Korean Health Insurance Review and Assessment Service database between 2005 and 2008 showed that 3.0% of patients aged >65 years had dementia at the time of hemodialysis initiation [19]. The lower prevalence of dementia compared to that in our study is possibly due to underdiagnosis during the coding procedure in the previous study.…”

Risk of Suicide Attempt after Thyroidectomy: A Nationwide Population Study in South Korea

“…HIRA data are anonymized to protect the privacy of individuals, and the HIRA provides individual numbers for researches that replace the social security numbers. The data are widely used in various fields of medical research [ 20 , 27 , 28 ]. The study protocol was approved by the Institutional Review Board of Samsung Medical Center (No.…”

“…The data are widely used in various fields of medical research. 20,27,28 The study protocol was approved by the Institutional Review Board of Samsung Medical Center (No. 2019-04-022).…”

Validation of operational definitions of mortality in a nationwide hemodialysis population using the Health Insurance Review and Assessment Service databases of Korea

“…All-cause mortality is the most objectively measurable surrogate endpoint because it has minimal chance of being affected by bias in patient selection, missing data, or misclassification of the cause of death [9]. Although it is ideal to merge NHIS data with that from Statistics Korea to investigate the time of death as well as the cause of death [10][11][12], analysis of all-cause mortality is feasible based on mortality information from the NHIS database. In the Korean HD population, alternatively, studies on all-cause mortality have been conducted using HIRA data by defining all-cause mortality as death where no claims were made for a certain period of time such as 30 days, 90 days, or more than 180 days [13][14][15][16].…”