Clinical characteristics and treatments in patients with chronic kidney disease and dementia

Background There is limited information on clinical features and treatments of patients with chronic kidney disease (CKD)–associated dementia. In this study, we assessed the difference in dementia diagnoses, cognitive function, and dementia treatment among patients with and without CKD. Method We included 20,032 patients with newly diagnosed dementia from the Swedish Dementia Registry (SveDem) within the region of Stockholm during 2006‐2018. Patient baseline kidney function was extracted from the Stockholm CREAtinine Measurements (SCREAM) project, and categorized by estimated glomerular filtration rate (eGFR) as ≥60, 30‐59, 15‐29, and <15 ml/min/1.73m 2 or dialysis. Dialysis patients were identified via linkage with Swedish Renal Registry. The difference in dementia diagnosis, cognitive function, dementia treatment among patients with different eGFR strata were examined. Confounders included demographics, living conditions, comorbidities, and therapies. Result Among the dementia patients 70% had GFR≥60ml/min, 27% GFR 30‐59ml/min, 2% GFR 15‐29ml/min and 1% <15 % ml/min or with dialysis. The proportion of vascular dementia increased across lower eGFR categories, while Alzheimer’s and mixed dementia, dementia with Lewy Bodies and Parkinson's disease dementia decreased. Patient diagnosis in nursing home, the use of renin‐angiotensin‐system‐inhibitors, calcium‐channel‐blockers, and statins increased while antipsychotics and antidepressants decreased. Compared with eGFR ≥60 ml/min, lower eGFR strata were associated with worse cognitive function (MMSE unit, adjusted β coefficient, ‐0.69, 95% confidence interval [‐1.22,‐0.17] for eGFR 15‐29ml/min and ‐1.50, (‐2.66,‐0.34) for eGFR<15ml/min or dialysis). After adjustment for patient demographics, living conditions, comorbidities, MMSE and therapies, lower eGFR strata were significantly associated with less prescription of acetylcholinesterase inhibitors (aChEIs) and memantines [Odds ratio 0.91(0.84‐0.99) in eGFR 30‐59ml/min and 0.20 (0.09‐0.46), in eGFR<15ml/min or dialysis for aChEIs; 0.91(0.83‐0.99) in eGFR 30‐59ml/min, 0.37 (0.25‐0.55) in eGFR 15‐29ml/min and 0.14(0.03‐0.58), in eGFR<15ml/min or dialysis for memantine use]. Conclusion Patients with advanced chronic kidney disease had worse cognitive function and less prescribed anti‐dementia drugs. Since we have previously shown that aChEI treatment is associated with lower mortality, the relationship between anti‐dementia medication, renal function and cognition must be further investigated.