Sometimes you just have to share bad information.  Like a few weeks ago, when I reported that data indicated the nature of the microbiome population in a mom’s gut is associated with the development of autism spectrum disorders in their children.  (My goal in publicizing this data was to alert parents-to-be of the issue- and to consider fecal transplantation if that issue could be applied to them.)

This one… Well, first I must share my bias.   Although I am an old fart, I have always had a problem (long before I began receiving Social Security and Medicare) with the concept of providing dialysis (not continuing- but starting) to those patients who are over the age of 80.  Not because those folks deserve to die- but the issues of dialysis (catheterization, thrice weekly regimen, travel [since the US government still frowns on paying for home dialysis, plus the costs involved and co-morbidity factors) really don’t call for such almost-superhuman efforts.  As of now, almost ½ (49.6%) of those initiating dialysis are over the age of 65- but, thankfully, the number of those surviving longer on dialysis is also increasing.

But, I had no idea about the association of age with dementia or Alzheimer’s incidence (ok- in general, yes- but…) with hemodialysis.  A new literature analysis (this is correlation and not causation, but still) was effected by Drs. M.A. McAdams-DeMarco, M. Daubresse, S. Bae, A.L. Gross, M.C. Carlson, and D.L. Segev of Johns Hopkins.  Their article, Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation (to be published soon in the Clinical Journal of the American Society of Nephrology). The researchers examined the data from 356,668 patients over 66 y of age who underwent dialysis from 2001 through 2013.  Of these subjects, with a mean age of 76, almost half (47%) were women and 1/5 (20%) were Black.

We already know that dementia is the leading cause of disability and dependence world-wide.  Alzheimer’s is the largest subset of dementia, accounting for about ½ the subjects who manifest dementia.

While the risks for dementia (1 y and 5 y) were 4.6% and 16% for women and 3.7% and 13% for men upon beginning dialysis, the Alzheimer’s incidence was lower (0.6% for women and 1.4% for men after 1 year).  Moreover, for patients NOT on dialysis (as found in the Framingham long-term health census study), the 10 year incidence for dementia is 1-1.5% for those 65 y of age and 7.4-7.6% of those who attained 75 y of age- compared to 19% and 28% if those folks are on dialysis!

But, it’s the increased morbidity that is correlated with those on dialysis that is scary.  Age is the primary factor- more so than gender, race, or if the subject has been institutionalized. 

(By the way, not shown, the data also indicated those who  manifest diabetes have lower morbidity factors than those who don’t- 2.05 vs. 2.09 for those who manifest dementia and 1.85 v. 2.31 for those diagnosed with Alzheimer’s.  I wonder why.)       

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