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

Authors
 Sung Min Jung  ;  Clara Tammy Kim  ;  Ea Wha Kang  ;  Kyoung Hoon Kim  ;  Shina Lee  ;  Hyung Jung Oh  ;  Seung-Jung Kim  ;  Duk-Hee Kang  ;  Kyu Bok Choi  ;  Dong-Ryeol Ryu  ;  Hyunwook Kim 
Citation
 BMC NEPHROLOGY, Vol.18(128) : 1-7, 2017 
Journal Title
BMC NEPHROLOGY
Issue Date
2017
MeSH
Aged ; Aged, 80 and over ; Brain Ischemia/epidemiology* ; Cause of Death ; Cerebral Hemorrhage/epidemiology* ; Dementia/epidemiology* ; Female ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/epidemiology ; Kidney Failure, Chronic/therapy* ; Male ; Mortality* ; Myocardial Infarction/epidemiology* ; Myocardial Revascularization/utilization ; Propensity Score ; Proportional Hazards Models ; Renal Dialysis* ; Republic of Korea/epidemiology ; Risk Factors ; Stroke/epidemiology*
Keywords
Dementia ; Hemodialysis ; Ischemic stroke ; Mortality
Abstract
BACKGROUND: Dementia 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.

METHODS: Using 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.

RESULTS: A 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.

CONCLUSIONS: Dementia 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.
Files in This Item:
T201701029.pdf Download
DOI
10.1186/s12882-017-0547-0
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyun Wook(김현욱) ORCID logo https://orcid.org/0000-0002-4274-7562
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154633
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