Older Adults Face High Rates of Dementia After Starting Kidney Dialysis

A new study uncovers high rates of dementia in older adults after they begin hemodialysis, a treatment purifying the blood of a patient whose kidneys are not functioning normally.

The findings, published in the Clinical Journal of the American Society of Nephrology (CJASN), also show that dementia in dialysis patients is tied to a greater risk of early death.

Older patients on hemodialysis often experience a significant decline in cognitive function while undergoing the treatment, which puts them at high risk for developing dementia. For the study, researchers from Johns Hopkins Bloomberg School of Public Health analyzed information on 356,668 hemodialysis patients aged 66 and older.

According to the findings, the 1- and 5-year risks of being diagnosed with dementia after initiating hemodialysis are 4.6 percent and 16 percent for women and 3.7 percent and 13 percent for men. The respective risks of being diagnosed with Alzheimer’s disease are 0.6 percent and 2.6 percent for women and 0.4 percent and 2.0 percent for men.

The researchers estimated that the 10-year risk of a post-hemodialysis dementia diagnosis is 19 percent for patients aged 66 to 70 years, rising to 28 percent for those 76-80 years.

The strongest risk factors for dementia and Alzheimer’s disease were being over the age of 86, black, female, and institutionalized (such as living in a nursing home). Also, older hemodialysis patients with a diagnosis of dementia or Alzheimer’s disease had a 2-fold higher risk of dying.

“We wanted to shed light on the high burden of diagnosed dementia in older patients with kidney failure who initiate hemodialysis,” said study leader Dr. Mara McAdams-DeMarco. “While we were able to study diagnosed dementia, there is a great need to also identify patients with mild cognitive impairment as well as undiagnosed dementia.”

In an accompanying editorial, Judy Weintraub of Los Angeles offered her perspective as a dialysis patient and chaplaincy candidate. She noted the need to emphasize a culture of respect and dignity for all, regardless of physical and cognitive abilities. Her recommendations for dialysis facilities include encouraging a sense of community, introducing music, and communicating with patients.

“This is a call for facility administrators and medical directors to institute policies from the top down to foster a shift in the way care is delivered,” she wrote. “Let’s institute in our policies and procedures not just what care is delivered, but how that care is delivered.”

Source: American Society of Nephrology


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