Kidney disease and risk of dementia: a Danish nationwide cohort study

Abstract

ObjectivesIt is unclear whether kidney disease is a risk factor for developing dementia. We examined the association between kidney disease and risk of future dementia.Design and settingNationwide historical registry-based cohort study in Denmark based on data from 1 January 1995 until 31 December 2016.ParticipantsAll patients diagnosed with kidney disease and matched general population cohort without kidney disease (matched 1:5 on age, sex and year of kidney disease diagnosis).Primary and secondary outcome measuresAll-cause dementia and its subtypes: Alzheimer’s disease, vascular dementia and other specified or unspecified dementia. We computed 5-year cumulative incidences (risk) and hazard ratios (HRs) for outcomes using Cox regression analyses.ResultsThe study cohort comprised 82 690 patients with kidney disease and 413 405 individuals from the general population. Five-year and ten-year mortality rates were twice as high in patients with kidney disease compared with the general population. The 5-year risk for all-cause dementia was 2.90% (95% confidence interval: 2.78% to 3.08%) in patients with kidney disease and 2.98% (2.92% to 3.04%) in the general population. Compared with the general population, the adjusted HRs for all-cause dementia in patients with kidney disease were 1.06 (1.00 to 1.12) for the 5-year follow-up and 1.08 (1.03 to 1.12) for the entire study period. Risk estimates for dementia subtypes differed substantially and were lower for Alzheimer’s disease and higher for vascular dementia.ConclusionsPatients diagnosed with kidney disease have a modestly increased rate of dementia, mainly driven by vascular dementia. Moreover, patients with kidney disease may be underdiagnosed with dementia due to high mortality and other comorbidities of higher priority.

Association of Kidney Function With Development of Alzheimer Disease and Other Dementias and Dementia-Related Blood Biomarkers

“…Previous research findings regarding kidney function and dementia risk have been mixed. In several longitudinal studies, including the largest to date, an association between kidney function and increased risk of vascular dementia but not AD was evident . In a registry-based study, lower kidney function, measured by the eGFR, was associated with an increased risk of dementia as well as AD diagnosis .…”

“…In several longitudinal studies, including the largest to date, an association between kidney function and increased risk of vascular dementia but not AD was evident. 4 , 22 , 23 In a registry-based study, lower kidney function, measured by the eGFR, was associated with an increased risk of dementia as well as AD diagnosis. 3 Longitudinal studies in Japan and England also showed associations between kidney function and incidence of dementia.…”

“…Increased understanding of the disease is critical to effective treatment, prevention, and use of AD biomarkers in the clinical setting. Kidney function has been previously associated with risk of dementia, including AD and vascular dementia . The literature regarding this association, however, has been inconsistent, with several studies showing no association between kidney function and dementia risk or cognitive decline …”

“…Kidney function has been previously associated with risk of dementia, including AD and vascular dementia. 3 , 4 , 5 The literature regarding this association, however, has been inconsistent, with several studies showing no association between kidney function and dementia risk or cognitive decline. 6 , 7 , 8 …”

Association of anticholinergic drug exposure with the risk of dementia among older adults in Japan: The LIFE Study

“…23,24 According to previous studies, we included patients with chronic heart failure, cardiac arrhythmias, valvular disease, pulmonary circulation disorders, peripheral vascular disease, hypertension, chronic pulmonary disease, diabetes, renal failure, liver disease, cancer, psychosis, and depression. 5,10,12,25 LTC need levels (support need levels 1-2 and care need levels 1-5) were certified by the municipality according to the degree of disability and instrumental activities of daily living. 26 The LTC need level of the participant was defined as the maximum LTC need level during the lookback period.…”