A population-based study of the association between hemodialysis and cognitive impairment

• Main Authors: Ying-Chi Lin, 林盈旗
• Other Authors: Ching-Wen Chien
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/34640916536097816008

碩士 === 國立陽明大學 === 醫務管理研究所 === 101 === Background and Objectives End-stage renal disease (ESRD) has been serious issues in public health as well as social welfare. The major modality of ESRD is hemodialysis however cognitive impairment of hemodialysis has getting attention form health authorities. In the past, the association between hemodialysis and cognitive impairment was not cleared because of confounding and confusing of comorbidities before hemodialysis. Therefore, the objective of this study was to used retrospective cohort study design to assess the association between hemodialysis and cognitive impairment while controlling for age, gender, urbanization of residence and comorbidities. Method and Variables This study was a retrospective cohort study using 2000 – 2007 the National Health Insurance Research Database, (NHIRD) one million enrollee dataset as data source. The case cohort was composed by new hemodialysis patients between 2003 and 200. The control cohort was formed by propensity score matching gender, age and urbanization of residence in 1:1 ratio. The final number of subjects in the case cohort were 545 and 2,180for the control cohort. Independent variable in this study was whether a subject had hemodialysis; dependent variables was whether a subject had cognitive impairment; and control variables were age, gender, urbanization of residence and Elixhauser comorbidities. T tests of means and standard deviations were used to compared days between hemodialysis and having cognitive impairment. Kaplan-Meier curves and log-rank test were used to assess the difference between two cohorts; and finally, Cox's Proportional Hazard Model were used to assessed the risk of acquiring cognitive impairment while age, gender, urbanization of residence and Elixhauser comorbidities were controlled for. The significant level was set to P<0.05. Results After following a total of 2,725subjects for two years, 40of them acquired cognitive impairment while the rest 2,685subjects were not.。Both groups were significantly different in hemodialysis. 524 subjects（19.52%）without cognitive impairment were hemodialysis while only 21（52.50%） subjects who were hemodialysis were cognitive impaired。In comorbidities, CHD, VSD, neurological disorders, DM, renal failure, anemia and age were significantly different between two groups（P<0.05）. Patients with cognitive impairment were older, 59.29±13.59, than without it, 70.35±10.29（P<0.001）. The log-rank test of Kaplan-Meier curves analysis reached significant difference（P<0.001）. Days between dialysis to cognitive impairment were 726.70±42.82 days for non-dialysis subjects and 716.37±82.25days for dialysis subjects and was significantly different. Cox's Proportional Hazard Model indicated that while gender, age, urbanization of residence and comorbidities were controlled for, hemodialysis had significant impact on cognitive impairment, and the risk of hemodialysis acquired cognitive impairment was 4.15 fold （Hazard Ratio=4.15） than without hemodialysis. The risk of acquired cognitive impairment increased by 1.08 fold（Hazard Ratio=1.08）when a subject gained one year of age. Gender, urbanization of residence and Elixhauser comorbidities had no impact on acquiring cognitive impairment. Discussion and Conclusion There are three findings need further discussion. First, hemodialysis were associated with cognitive impairment. Second, age and cognitive impairment were significantly associated disregard any comorbidities before hemodialysis began. Third, there were no evidence that comorbidities were associated with cognitive impairment after hemodialysis. Keywords: Hemodialysis、Cognitive impairment、End-stage renal disease