Kidney Centre, Toranomon Hospital, Tokyo, Japan.
Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
BMJ Open. 2020 May 17;10(5):e033811. doi: 10.1136/bmjopen-2019-033811.
To investigate the association between chronic kidney disease (CKD) and dementia diagnosis in a real-world primary care setting in England.
Matched cohort study.
English primary care in the Clinical Practice Research Datalink.
People aged ≥18 years with predialysis CKD (stages 3-5, defined as two measurements of estimated glomerular filtration rate <60 mL/min/1.73 m for 3 months) from 2004 to 2014, and people without known CKD who were matched on age, sex, general practice and calendar time in a 1:1 ratio.
First-ever diagnosis of dementia recorded by GPs. We also examined all-cause death as a secondary outcome to discuss potential competing risk of mortality in the association between CKD and dementia diagnosis.
In a matched cohort of 242 349 pairs with and without CKD (mean age 75.4±9.7 years, 39.3% male), the crude incidence rate of dementia diagnosis was 11.4/1000 and 9.4/1000 person-years, respectively. There was an association between CKD status and incident dementia diagnosis in the first 6 months of the follow-up (adjusted rate ratio (aRR) 1.58, 95% CI 1.44 to 1.74), which attenuated after 6 months (aRR 1.12, 95% CI 1.08 to 1.16). Among patients with CKD, there was no evidence of association between CKD stage and incident dementia diagnosis; compared with stage 3a, aRR (95% CI) was 1.04 (0.91 to 1.18) for stage 3b and 0.94 (0.74 to 1.20) for stages 4 or 5 in the first 6 months, and 0.97 (0.92 to 1.01) and 0.89 (0.80 to 0.98) thereafter. We found a strong association between worsening CKD stage and all-cause mortality.
We identified a co-occurrence of detection of CKD and dementia in real-world clinical practice and a strong competing risk of mortality in the association between CKD stage and dementia, while a weak association between CKD status and dementia was suggested in the long term.
在英国的真实初级保健环境中，研究慢性肾脏病（CKD）与痴呆诊断之间的关联。
匹配队列研究。
临床实践研究数据链接中的英国初级保健。
2004 年至 2014 年间，年龄≥18 岁且处于透析前 CKD（3-5 期，定义为两次肾小球滤过率估计值<60mL/min/1.73m，持续 3 个月）的患者；以及年龄、性别、一般实践和日历时间相匹配的无已知 CKD 的患者，匹配比例为 1:1。
GP 记录的首次痴呆诊断。我们还检查了全因死亡作为 CKD 和痴呆诊断之间关联的潜在竞争风险。
在 242349 对有和没有 CKD 的匹配队列中（平均年龄 75.4±9.7 岁，39.3%为男性），痴呆诊断的粗发生率分别为 11.4/1000 和 9.4/1000 人年。在随访的前 6 个月中，CKD 状态与新发痴呆诊断之间存在关联（调整后的比率比[aRR]1.58，95%CI1.44 至 1.74），在 6 个月后这种关联减弱（aRR1.12，95%CI1.08 至 1.16）。在 CKD 患者中，CKD 分期与新发痴呆诊断之间无关联证据；与 3a 期相比，3b 期的 aRR（95%CI）为 1.04（0.91 至 1.18），4 或 5 期为 0.94（0.74 至 1.20），此后为 0.97（0.92 至 1.01）和 0.89（0.80 至 0.98）。我们发现 CKD 分期恶化与全因死亡率之间存在很强的关联。
我们在真实临床实践中发现了 CKD 和痴呆的同时检测，以及 CKD 分期与痴呆之间存在强烈的竞争死亡风险，而在长期内，CKD 状态与痴呆之间的关联则较弱。
