title: Dementia is a risk factor for major adverse cardiac and cerebrovascular events in elderly Korean patients initiating hemodialysis: a Korean national population-based study.
abstract: 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.
authors.affiliation: Department of Internal Medicine, College of Medicine, Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Korea.
authors.forename: Sung Min
authors.initials: SM
authors.lastname: Jung
authors.affiliation: Graduate School of Public Health, Seoul National University, Seoul, Korea.
authors.forename: Clara Tammy
authors.initials: CT
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Goyang-si, Gyunggi-do, Korea.
authors.forename: Ea Wha
authors.initials: EW
authors.lastname: Kang
authors.affiliation: Department of Public Health, Graduate School, Korea University, Seoul, Korea.
authors.forename: Kyoung Hoon
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Korea.
authors.forename: Shina
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, College of Medicine, Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Korea.
authors.forename: Hyung Jung
authors.initials: HJ
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, College of Medicine, Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Korea.
authors.forename: Duk-Hee
authors.initials: DH
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, College of Medicine, Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Korea.
authors.forename: Kyu Bok
authors.initials: KB
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, College of Medicine, Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Korea. drryu@ewha.ac.kr.
authors.forename: Dong-Ryeol
authors.initials: DR
authors.lastname: Ryu
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine Gangnam Severance Hospital, Seoul, Korea. bluejayway@naver.com.
authors.forename: Hyunwook
authors.identifier: 0000-0002-4274-7562
authors.initials: H
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology*; D002423:Cause of Death; D002543:Cerebral Hemorrhage / Q000453:epidemiology*; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D057216:Propensity Score; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*
keywords: Dementia; Hemodialysis; Ischemic stroke; Mortality