Dementia as a Predictor of Mortality in Dialysis Patients

The life expectancy of patients who have dementia and are initiated on dialysis in the United States has not been described in the medical literature. A retrospective cohort study was conducted of 272,024 Medicare/Medicaid primary patients in the US Renal Data System who were started on ESRD therapy...

Full description

Saved in:
Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2006-09, Vol.1 (5), p.1000-1005
Main Authors: Rakowski, Daniel A, Caillard, Sophie, Agodoa, Lawrence Y, Abbott, Kevin C
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cohort Studies
Dementia - complications
Dementia - mortality
Female
Humans
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - therapy
Logistic Models
Male
Medicaid - statistics & numerical data
Medicare - statistics & numerical data
Middle Aged
Odds Ratio
Patient Selection
Proportional Hazards Models
Registries
Renal Dialysis - statistics & numerical data
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
United States - epidemiology
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The life expectancy of patients who have dementia and are initiated on dialysis in the United States has not been described in the medical literature. A retrospective cohort study was conducted of 272,024 Medicare/Medicaid primary patients in the US Renal Data System who were started on ESRD therapy between April 1, 1995, and December 31, 1999, and followed through December 31, 2001. Cox regression was used to calculate adjusted hazard ratios for risk for death after initiation of dialysis for patients whose dementia was diagnosed before the initiation of dialysis as shown by Medicare claims. The average time to death for patients with dementia was 1.09 versus 2.7 yr (P < 0.001) with an adjusted hazard ratio of 1.87 (95% confidence interval 1.77 to 1.98). The 2-yr survival for patients with dementia was 24 versus 66% for patients without dementia (P < 0.001 via log rank test). Dementia that is diagnosed before initiation on dialysis is an independent risk factor for subsequent death. Such patients should be considered for time-limited trials of dialysis and careful discussion in choosing whether to pursue initiation of dialysis or palliative care.
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.00470705