The online version of this article (doi:10.1186/s12882-017-0547-0) contains supplementary material, which is available to authorized users.
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.
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.
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.
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.
Additional file 1: Table S1. Results of the Cox proportional hazards analysis for MACCE in all patients (N = 10,171). Table S2. Results of the Cox proportional hazards analysis for MACCE in propensity score-matched patients (N = 756). Abbreviations: MACCE, major adverse cardiac and cerebrovascular event. (DOCX 23 kb)12882_2017_547_MOESM1_ESM.docx
Additional file 2: Figure S1. Kaplan Kaplan–Meier event-free survival curves and comparisons between patients with and without dementia by log-rank test in propensity score-matched patients (N = 756). (A) The incidence of MACCE was significantly higher in patients with dementia than those without dementia (P = 0.0304). (B) Patients without dementia showed better survival rate compared to patients with dementia (P = 0.0348). (C-E) There were no significant differences in event-free survival rates of nonfatal acute myocardial infarction, target vessel revascularization, and nonfatal hemorrhagic stroke (P = 0.31, P = 0.133, and P = 0.402, respectively). (F) However, the incidence of nonfatal ischemic stroke was significantly higher in patients with dementia than those without dementia (P = 0.0492). Abbreviations: MACCE, major adverse cardiac and cerebrovascular event. (TIF 476 kb)12882_2017_547_MOESM2_ESM.tif
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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
Sung Min Jung
Clara Tammy Kim
Ea Wha Kang
Kyoung Hoon Kim
Hyung Jung Oh
Kyu Bok Choi
- BioMed Central
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