Nakano Yuta, Mandai Shintaro, Mori Yutaro, Ando Fumiaki, Mori Takayasu, Susa Koichiro, Iimori Soichiro, Naito Shotaro, Sohara Eisei, Fushimi Kiyohide, Uchida Shinichi
Department of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, Japan.
Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, Japan.
Kidney Int Rep. 2025 Apr 17;10(7):2424-2435. doi: 10.1016/j.ekir.2025.04.018. eCollection 2025 Jul.
Unplanned dialysis initiation (UDI) is associated with poor outcomes and high medical costs. Although aging is a prominent risk factor for UDI, the roles of age-related factors such as cognitive impairment and physical dysfunction remain underexplored. This study aimed to clarify the associations of cognitive impairment and physical dysfunction with UDI and additional medical costs.
This study used a Japanese administrative claims database to analyze 79,850 patients aged ≥ 65 years (median age: 76 ys; 31.6% females) who began receiving dialysis. UDI was defined as starting dialysis with a temporary catheter. Physical function and cognitive impairment were classified based on mobility and daily living abilities. We assessed the association using logistic regression. Additional medical costs were estimated via generalized linear regression.
UDI occurred in 16,176 patients (20%). Compared with the normal group, the odds ratios (ORs) for UDI were 1.58 (95% confidence interval [CI]: 1.49-1.67) for low physical function, 1.70 (95% CI: 1.58-1.82) for very low, and 2.22 (95% CI: 2.09-2.35) for extremely low physical function. For cognitive impairment, the ORs were 1.02 (95% CI: 0.96-1.08) for mild impairment and 1.26 (95% CI: 1.14-1.39) for severe impairment relative to normal. The average marginal cost of UDI was $7178 [95% CI: $7019-$7338] per admission. A combination of physical dysfunction and cognitive impairment further increased UDI risk and inpatient care costs.
Older adults with cognitive impairment and physical dysfunction face a higher risk of UDI. Early intervention for these patients may reduce UDI and its associated costs.
非计划内开始透析（UDI）与不良预后及高昂的医疗成本相关。尽管衰老是非计划内开始透析的一个突出风险因素，但认知障碍和身体功能障碍等与年龄相关的因素的作用仍未得到充分研究。本研究旨在阐明认知障碍和身体功能障碍与非计划内开始透析及额外医疗成本之间的关联。
本研究使用日本行政索赔数据库，分析了79850名年龄≥65岁（中位年龄：76岁；女性占31.6%）开始接受透析的患者。非计划内开始透析被定义为通过临时导管开始透析。根据活动能力和日常生活能力对身体功能和认知障碍进行分类。我们使用逻辑回归评估关联。通过广义线性回归估计额外的医疗成本。
16176名患者（20%）出现非计划内开始透析。与正常组相比，身体功能低下者非计划内开始透析的比值比（OR）为1.58（95%置信区间[CI]：1.49 - 1.67），身体功能极低者为1.70（95% CI：1.58 - 1.82），身体功能极度低下者为2.22（95% CI：2.09 - 2.35）。对于认知障碍，相对于正常情况，轻度障碍的OR为1.02（95% CI：0.96 - 1.08），重度障碍的OR为1.
