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CKD Progression with Dementia in Diabetes Linked to Mortality

May 28, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Maya Rudolph, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate

CKD progression with dementia: can a patient with type 2 diabetes diagnosed with dementia have increased rate of mortality?

Researchers have shown that patients with type 2 diabetes who are diagnosed with dementia are prone to developing vascular events such as chronic kidney disease (CKD). Type 2 diabetes is a leading factor in CKD, with CKD being a faster growing cause of death. Over time, high glucose levels can damage the blood vessels in the kidneys. High blood pressure can also occur in patients with diabetes, which can also damage the kidneys. Data suggest that patients with CKD are also at a higher risk of developing dementia. Dementia association with diabetes happens when glucose is not used properly in the brain and causes nerve cell death, which prevents the brain from communication or sending messages to itself. Studies have shown that in dementia, beta amyloid plaques build in the brain causing an impact on insulin receptors not being able to do their job in the brain. Thus, insulin production is altered, and brain cells become less sensitive to insulin. With type 2 diabetes having the potential to cause both life-threatening illnesses, dementia and CKD, the alarming topic of mortality has been brought into play. The National Kidney Foundation 2019 Clinical Meeting in Boston presented the study findings on patients with type 2 diabetes and dementia having a greater risk for CKD which can lead to mortality.

At the clinical meeting, the National Kidney Foundation summarized a large cohort study from the University of Kansas Medical Center in Kansas City on veterans with type 2 diabetes. In the study, 93,062 of the veterans did not have dementia and 9,205 of the veterans did have dementia. Both groups were characterized by sex, prior kidney function, usage of ACEIs and/or ARBs, and their follow up time. An 8-year time span (2,998 days) was the mean for the progression of a vascular event after a dementia diagnosis in the patients.

Patients with dementia showed a more significant CKD progression based off serum creatinine levels. Serum creatinine (SCr) values exceeded in patients with dementia vs. those patients without; 38.9% vs. 12.6% in SCr more than 1.5 mg/dl, 8.6% vs. 7.2% in SCr more than 3 mg/dl, 3.2% vs. 2.7% in SCr more than 6 mg/dl, respectively. Studies showed that CKD progressed rapidly in patients with dementia.

Patients with type 2 diabetes and dementia were also faced with other vascular events. The vascular events that were more likely to occur in these patients with dementia vs patients without dementia included: coronary artery disease (9.2% vs. 7.9%), myocardial infarction (2.8 % vs. 1.7%), and cerebrovascular accidents (10.6% vs. 4.8%), respectively. Subsequently, 24.6 % vs. 12.6% of patients with dementia died from any vascular event than the patients without dementia.

The study the National Kidney Foundation reviewed referenced a similar study from the US Renal Data System that also showed how dementia complicates treatments in comorbidities such as CKD, which can increase the risk of mortality. This clinical trial estimated the risk factors and causes of dementia and Alzheimer’s disease among older patients with CKD after hemodialysis initiation. The study examined that one of the causes of CKD is having type 2 diabetes. The results summed that older patients with a diagnosis of dementia or Alzheimer’s disease on hemodialysis had a twofold higher mortality risk.

Newer studies have found that nearly half of patients with type 2 diabetes are undiagnosed with CKD; therefore reasoning that the need to educate these patients about the potentially life-threatening disease is critical. The clinical meeting in Boston stressed the importance of the decreased cognition associated with dementia in patients with type 2 diabetes suffering from chronic kidney disease. Dr. Gupta, who presented at the clinical meeting, commented that vascular events in these patients are associated with higher risk of mortality.

Practice Pearls:

  • A dementia diagnosis can precede with vascular complications leading to death in patients with type 2 diabetes.
  • Patients with dementia showed a significant progression of CKD based off patient’s serum creatinine.
  • It is important for medical professionals to educate and routinely check the serum creatinine levels in patients with type 2 diabetes diagnosed with dementia.

References:

Bugnicourt, Jean-Marc, et al. “Cognitive Disorders and Dementia in CKD: The Neglected Kidney-Brain Axis.” American Society of Nephrology, American Society of Nephrology, 1 Mar. 2013, jasn.asnjournals.org/content/24/3/353

DeMarco-McAdams, Mary A. “Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation.” American Society of Nephrology., 13 September 2018, https://cjasn.asnjournals.org/content/clinjasn/13/9/1339.full.pdf.

“Diabetes and Dementia – Is There a Connection?” Alzheimer Society of Canada, Alzheimer Society, alzheimer.ca/en/Home/About-dementia/Alzheimer-s-disease/Risk-factors/Diabetes-dementia-connection.

“Diabetic Kidney Disease.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 Feb. 2017, www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-kidney-disease.

“New Study Finds Chronic Kidney Disease Remains Largely Undiagnosed in Nearly Half of Patients with Type 2 Diabetes and Chronic Kidney Disease.” Content Lab – U.S., Johnson & Johnson, Inc., 10 May 2019, www.jnj.com/new-study-finds-chronic-kidney-disease-remains-largely-undiagnosed-in-nearly-half-of-patients-with-type-2-diabetes-and-chronic-kidney-disease.

Persaud, Natasha. “Dementia Predicts CKD Progression, Death in Type 2 Diabetes.” Renal and Urology News, Renal and Urology News, 9 May 2019, www.renalandurologynews.com/home/conference-highlights/national-kidney-foundation-annual-meeting/nkf-2019-spring-conference/dementia-predicts-kidney-disease-progression-death-diabetes-patients/.

 

Maya Rudolph, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate