Survival and cognitive deterioration in elderly patients undergoing hemodialysis.

AIM: This study aimed to elucidate the 5-year changes in the cognitive function of elderly patients undergoing hemodialysis and its association with survival and related factors. METHODS: Cognitive function in patients aged ≥65 years undergoing hemodialysis at the Nagasaki Renal Center was assessed using the Mini-Mental State Examination (MMSE) in 2016. Patients were subsequently classified into normal, mild cognitive impairment (MCI) and suspected dementia groups according to their scores; MMSE was conducted at 30 and 60 months thereafter. The patients were followed until 2021. The association between survival and patient backgrounds was analyzed. RESULTS: Of the 181 patients, 168 completed follow-up and were classified into normal (n = 71, 42.3%), MCI (n = 44, 26.1%), and suspected dementia (n = 53, 31.5%) groups. Multivariable logistic regression analysis showed that age, female sex, and geriatric nutritional risk index were associated with MMSE scores <24. The 5-year survival rates were 60.6%, 40.9%, and 22.6% in the normal, MCI and suspected dementia groups, respectively. With some exceptions, MMSE results tended to decline during the observation period. A multivariate Cox proportional hazards model showed that age (hazard ratio [HR], 1.04; P = 0.007), dialysis vintage (HR, 0.96; P = 0.04), male sex (HR, 1.77; P = 0.02), geriatric nutritional risk index (HR, 0.94; P < 0.001) and MMSE score (HR, 0.96; P = 0.01) were independent risk factors for patient survival. CONCLUSIONS: Cognitive impairment in patients undergoing hemodialysis was associated with age and nutritional status. Patients with cognitive impairment had a poor prognosis. Geriatr Gerontol Int 2023; 23: 111-116.

Poor prognosis after lower-limb amputation irrespective of diabetes status in patients undergoing hemodialysis.

INTRODUCTION: Diabetes mellitus is one of the most important risk factors for lower-limb amputation in patients undergoing hemodialysis. However, the influence of diabetes mellitus on survival after lower-limb amputation is unknown. METHODS: Patients who underwent lower-limb amputation since 1996 (amputation group) and those who underwent hemodialysis during 2011-2012 (control group) were included and were followed up until July 2022. RESULTS: There were 70 patients (age: 66.3 ± 8.2 years, 80% male, 77% diabetic) in the amputation group and 328 (age: 67.5 ± 13.5 years, 56% male, 33% diabetic) in the control group. The amputation group showed a poorer prognosis than the control group (hazard ratio [HR]: 2.41, p < 0.001). In the control group, patients with diabetes exhibited poorer survival than those without diabetes (HR: 1.86, p < 0.001). In the amputation group, patients with diabetes exhibited improved survival (HR: 0.47, p = 0.02). CONCLUSION: Patients undergoing hemodialysis who underwent lower-limb amputation exhibited a poor prognosis, irrespective of diabetes status.