Cognitive Impairment and Physical Dysfunction Associated With Unplanned Dialysis Initiation
Introduction: 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 a...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
|
| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024925002384 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849473097236742144 |
|---|---|
| author | Yuta Nakano Shintaro Mandai Yutaro Mori Fumiaki Ando Takayasu Mori Koichiro Susa Soichiro Iimori Shotaro Naito Eisei Sohara Kiyohide Fushimi Shinichi Uchida |
| author_facet | Yuta Nakano Shintaro Mandai Yutaro Mori Fumiaki Ando Takayasu Mori Koichiro Susa Soichiro Iimori Shotaro Naito Eisei Sohara Kiyohide Fushimi Shinichi Uchida |
| author_sort | Yuta Nakano |
| collection | DOAJ |
| description | Introduction: 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. Methods: 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. Results: 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. Conclusion: 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. |
| format | Article |
| id | doaj-art-957e790619da4a00a02e76eb6f564db3 |
| institution | Kabale University |
| issn | 2468-0249 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-957e790619da4a00a02e76eb6f564db32025-08-20T03:24:16ZengElsevierKidney International Reports2468-02492025-07-011072424243510.1016/j.ekir.2025.04.018Cognitive Impairment and Physical Dysfunction Associated With Unplanned Dialysis InitiationYuta Nakano0Shintaro Mandai1Yutaro Mori2Fumiaki Ando3Takayasu Mori4Koichiro Susa5Soichiro Iimori6Shotaro Naito7Eisei Sohara8Kiyohide Fushimi9Shinichi Uchida10Department of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, JapanDepartment of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, Japan; Correspondence: Shintaro Mandai, Department of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan.Department of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, JapanDepartment of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, JapanDepartment of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, JapanDepartment of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, JapanDepartment of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, JapanDepartment of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, JapanDepartment of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, JapanDepartment of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, JapanDepartment of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Bunkyo, Tokyo, JapanIntroduction: 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. Methods: 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. Results: 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. Conclusion: 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.http://www.sciencedirect.com/science/article/pii/S2468024925002384agingcognitive impairmentdialysisend-stage kidney diseasephysical dysfunction |
| spellingShingle | Yuta Nakano Shintaro Mandai Yutaro Mori Fumiaki Ando Takayasu Mori Koichiro Susa Soichiro Iimori Shotaro Naito Eisei Sohara Kiyohide Fushimi Shinichi Uchida Cognitive Impairment and Physical Dysfunction Associated With Unplanned Dialysis Initiation Kidney International Reports aging cognitive impairment dialysis end-stage kidney disease physical dysfunction |
| title | Cognitive Impairment and Physical Dysfunction Associated With Unplanned Dialysis Initiation |
| title_full | Cognitive Impairment and Physical Dysfunction Associated With Unplanned Dialysis Initiation |
| title_fullStr | Cognitive Impairment and Physical Dysfunction Associated With Unplanned Dialysis Initiation |
| title_full_unstemmed | Cognitive Impairment and Physical Dysfunction Associated With Unplanned Dialysis Initiation |
| title_short | Cognitive Impairment and Physical Dysfunction Associated With Unplanned Dialysis Initiation |
| title_sort | cognitive impairment and physical dysfunction associated with unplanned dialysis initiation |
| topic | aging cognitive impairment dialysis end-stage kidney disease physical dysfunction |
| url | http://www.sciencedirect.com/science/article/pii/S2468024925002384 |
| work_keys_str_mv | AT yutanakano cognitiveimpairmentandphysicaldysfunctionassociatedwithunplanneddialysisinitiation AT shintaromandai cognitiveimpairmentandphysicaldysfunctionassociatedwithunplanneddialysisinitiation AT yutaromori cognitiveimpairmentandphysicaldysfunctionassociatedwithunplanneddialysisinitiation AT fumiakiando cognitiveimpairmentandphysicaldysfunctionassociatedwithunplanneddialysisinitiation AT takayasumori cognitiveimpairmentandphysicaldysfunctionassociatedwithunplanneddialysisinitiation AT koichirosusa cognitiveimpairmentandphysicaldysfunctionassociatedwithunplanneddialysisinitiation AT soichiroiimori cognitiveimpairmentandphysicaldysfunctionassociatedwithunplanneddialysisinitiation AT shotaronaito cognitiveimpairmentandphysicaldysfunctionassociatedwithunplanneddialysisinitiation AT eiseisohara cognitiveimpairmentandphysicaldysfunctionassociatedwithunplanneddialysisinitiation AT kiyohidefushimi cognitiveimpairmentandphysicaldysfunctionassociatedwithunplanneddialysisinitiation AT shinichiuchida cognitiveimpairmentandphysicaldysfunctionassociatedwithunplanneddialysisinitiation |