Delirium in hemodialysis predicts mortality: a single-center, long-term observational study
Authors Yasui-Furukori N, Tarakita N, Uematsu W, Saito H, Nakamura K, Ohyama C, Sugawara N
Received 22 September 2017
Accepted for publication 15 November 2017
Published 14 December 2017 Volume 2017:13 Pages 3011—3016
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Taro Kishi
Norio Yasui-Furukori,1 Natsumi Tarakita,1 Waka Uematsu,2 Hisao Saito,2 Kazuhiko Nakamura,1 Chikara Ohyama,3 Norio Sugawara4
1Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, 2Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, 3Department of Urology, Graduate School of Medicine, Hirosaki University, Hirosaki, 4Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
Objectives: Delirium signifies underlying brain dysfunction; however, its clinical significance in hemodialysis remains unclear. In this study, we sought to determine whether the occurrence of delirium during hemodialysis was associated with higher mortality.
Patients and methods: This was a retrospective, 10-year cohort study. This study was performed at the urology department located within a hospital in Oyokyo, Hirosaki. We analyzed 338 of 751 patients who underwent hemodialysis. Psychiatrists diagnosed patients with delirium according to the corresponding DSM-IV-TR criteria. Cox proportional hazard regression, which was adjusted for patient age at the time of hemodialysis initiation, sex, and the presence of diabetes mellitus, was performed. Hazard ratios (HRs) and their 95% CIs were also reported.
Results: In total, 286 patients without psychiatric diseases and 52 patients with delirium were evaluated. Eighty percent of patients with delirium died within 1 year of hemodialysis initiation, while only 22% of patients without delirium died within the same time period (P<0.01). Kaplan–Meier plots demonstrated the existence of associations between delirium and all-cause mortality (global log-rank P<0.001), cardiovascular disease-related mortality (global log-rank P<0.001), and infection-related mortality (global log-rank P<0.001). Moreover, Cox proportional hazard regression showed that delirium was associated with all-cause mortality (HR=1.96, 95% CI: 1.32–2.90), cardiovascular disease-related mortality (HR=2.65, 95% CI: 1.31–5.35), and infection-related mortality (HR=3.30, 95% CI: 1.34–8.10).
Conclusion: Delirium is an independent predictor of death in patients undergoing hemodialysis.
Keywords: delirium, hemodialysis, mortality, observational study, disturbance of consciousness
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