Role of Anemia in Dementia Risk Among Veterans With Incident CKD

Details

• Alternative Title:
  Am J Kidney Dis
• Personal Author:
  Koyama, Alain K. ; Nee, Robert ; Yu, Wei ; Choudhury, Devasmita ; Heng, Fei ; Cheung, Alfred K. ; Norris, Keith C. ; Cho, Monique E. ; Yan, Guofen
• Description:
  Rationale & Objective:
  
  While some evidence exists of increased dementia risk from anemia, it is unclear if this association persists among adults with CKD. Anemia may be a key marker for dementia among adults with CKD. We therefore evaluated if anemia is associated with an increased risk of dementia among adults with CKD.
  
  Study Design:
  
  Retrospective cohort study.
  
  Setting & Participants:
  
  The study included 620,095 veterans aged ≥45 years with incident stage 3 CKD (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) between January 2005 and December 2016 in the US Veterans Health Administration system and followed through December 31, 2018 for incident dementia, kidney failure or death.
  
  Exposures:
  
  Anemia was assessed based on the average of hemoglobin levels (g/L) during the two years prior to the date of incident CKD and categorized as normal, mild and moderate/severe anemia (≥12.0, 11.0–11.9, <11.0 g/dL, respectively for women and ≥13.0, 11.0–12.9, <11.0 g/dL for men).
  
  Outcomes:
  
  Dementia and the composite outcome of kidney failure or death.
  
  Analytical Approach:
  
  Adjusted cause-specific hazard ratios were estimated for each outcome.
  
  Results:
  
  At the time of incident CKD, mean age was 72 years, 97% were male, and mean eGFR was 51 mL/min per 1.73 m2. Over a median 4.1 years of follow-up, 92,306 (15%) veterans developed dementia before kidney failure or death. Compared to veterans with CKD without anemia, multivariable-adjusted models showed a 16% (95% confidence interval [CI] 14% to 17%) significantly higher risk of dementia for those with mild anemia and a 27% (95% CI 23% to 31%) higher risk with moderate/severe anemia. Combined risk of kidney failure or death was higher at 39% (95% CI 37% to 40%) and 115% (95% CI 112% to 119%) for mild and moderate/severe anemia, respectively, compared to no anemia.
  
  Limitations:
  
  Residual confounding from the observational study design. Findings may not be generalizable to the broader U.S. population.
  
  Conclusions:
  
  Anemia was significantly associated with increased risk of dementia among veterans with incident CKD, underscoring the role of anemia as a predictor of dementia risk.
  
  
• Subjects:
  Adult Aged Anemia Cohort Studies Dementia Female Glomerular Filtration Rate Humans Male Renal Insufficiency Renal Insufficiency, Chronic Retrospective Studies Risk Factors United States Veterans

  More +
• Keywords:
  Anemia Chronic Kidney Disease Dementia ESKD Kidney Failure
• Source:
  Am J Kidney Dis. 82(6):706-714
• Pubmed ID:
  37516301
• Pubmed Central ID:
  PMC10822015
• Document Type:
  Journal Article
• Funding:
  R01 DK112008/DK/NIDDK NIH HHSUnited States/ ; RES 13-457/RD/ORD VAUnited States/ ; SDR 02-237/HX/HSRD VAUnited States/ ; UL1 TR000124/TR/NCATS NIH HHSUnited States/ ; P30 AG021684/AG/NIA NIH HHSUnited States/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/ ; UL1 TR001881/TR/NCATS NIH HHSUnited States/
• Volume:
  82
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:7a143d2f5811adcfc97c148656d9057cfc3f1b55aa9caec56a196d59229f2a293696960a928dee0cba6038fcc78770e4c31a7ea5a6560c150c676b1b073982d8
• Download URL:
  https://stacks.cdc.gov/view/cdc/147657/cdc_147657_DS1.pdf
• File Type:
  [PDF - 562.45 KB ]