NEWS & PERSPECTIVE
A large register-based study from Sweden identified chronic kidney disease as a risk factor for dementia in older adults
Chronic kidney disease (CKD), defined as the persistent reduction in kidney function, is a growing health concern in the elderlies with an estimated global mean prevalence of 34.3% for populations over the age of 70-years-old.1 Associated with multiple comorbidities, reduced kidney function is a strong predictor of hospitalization, poor quality-of-life, and most importantly, cognitive dysfunction.1 In a recent large-scale study in Sweden, the link between dementia incidence and kidney function, as defined by estimated glomerular filtration rate (eGFR), was identified in a large population of older adults over the age of 65-years-old.2
Currently, identifying potential risk factors is one of the viable strategies in preventing dementia.3 Where some studies showed an association between CKD and a higher prevalence of cognitive impairment and faster decline in cognitive function, epidemiologic data also suggested that individuals at all stages of CKD had a higher risk of developing dementia and cognitive disorders than those without CKD.3,4 To evaluate the possibility of using CKD as a predictor to dementia, a study was conducted to explore the risk of dementia across the full spectrum of kidney function, with serial measures of eGFR, in a large Sweden population aged 65-years-old and above.3
The study analyzed the association between eGFR and the risk of dementia, defined as a new dementia diagnosis or initiation of dementia treatments, among more than 329,000 older residents of Stockholm who accessed healthcare during 2006 to 2011, were at least 65-years-old and had no history of dementia or underwent kidney replacement therapy.3 During a median follow-up of 5 years, 5.8% of participants were diagnosed with dementia with higher incidence rates (IRs) observed among those with lower eGFR or CKD at stage 3 or above.3 The IRs rose progressively from 6.56 per 1,000 patient-years (py) in participants with an eGFR of 90-104mL/min/1.73m2 to 30.3 per 1,000py in those with an eGFR below 30mL/min/1.73m2.3 Notably, participants with moderate CKD (eGFR 30-59mL/min/1.73m2) had a 71% higher risk of developing dementia (HR=1.71; 95% CI: 1.54-1.91; p<0.001) that increased to 162% higher risk (HR=2.62; 95% CI: 1.91-3.58; p<0.001) among those with severe kidney dysfunction (eGFR below 30mL/min/1.73m2) when compared to those with normal kidney function (eGFR 90-104mL/min/1.73m2).3
In addition, the study also estimated the rate of eGFR deterioration in a subgroup of over 205,000 participants.3 Through repeated eGFR measurements during the first year of observation, a steeper eGFR decline of over 2mL/min/1.73m2/year within one year was found to infer a higher risk of all-cause dementia, and in particular, vascular dementia.3 A similar but less clear association was also observed between the rate of eGFR decline and the risk of Alzheimer’s dementia.3 Assuming a direct association, up to 10% (95% CI: 6-14%) of dementia cases could be attributed to CKD, which was proportionally higher than that attributed to other dementia risk factors such as cardiovascular disease (CVD) and diabetes.3
Given the increase in life expectancy and the aging population in industrialized countries, the burden of dementia associated with CKD is expected to worsen.4 With this study concluding the inverse linear association between kidney function and dementia, a rapid decline in kidney function can now be used as a significant predictor to dementia similar to CVD.3 By raising the awareness of the association between these two conditions, appropriate strategies for dementia screening can be developed in patients with CKD, as well as healthcare service planning to ease the burden of both CKD and dementia and improve the quality-of-life of these elderly patients.3
Nirmatrelvir-ritonavir therapy demonstrated manageable tolerability among COVID-19 patients with CKD
Despite being an effective oral antiviral therapy for coronavirus 2019 (COVID-19), nirmatrelvir-ritonavir was not approved for patients with an estimated glomerular filtration rate (eGFR) <30mL/min/1.75m2.1 This can be attributed to a phenomenon known as “renalism”, which is the frequent exclusion o
IHD leads to poor brain health regardless of WMH
It is well known that traditional cardiovascular (CV) risk factors cause cerebrovascular events.1 Stroke is the first widely examined measure of vascular brain health as it can be quantified and clinically confirmed with neuroimaging.1 Advancement in brain imaging technology allows for a better understanding of the impacts of other vascular risk factors like white matter hyperintensity (WMH) or the downstream impacts of vascular brain health like dementia.1 Recently, the effects of ischemic heart disease (IHD) have been revealed to be an independent risk factor for brain aging and dementia, highlighting the importance of IHD prevention in delaying brain deterioration.2
Dapagliflozin reduces ESKD risk in geriatric CKD patients with comorbidities: A local case sharing
The prevalence of chronic kidney disease (CKD) among the elderly population is on the rise.1,2 The incidence of advanced-stageCKD increased sharply with advancing age.3 When compared with the younger counterparts, older patients with advanced CKD are more likely to be intolerable to conventional therapies, such as angiotensin-converting enzyme inhibitors (ACEis)or angiotensin receptor blockers (ARBs).2,3 In 2021, dapagliflozin was approved for the treatment of patients regardless of type 2 diabetes (T2D), providing an additional treatment option to address the medical gap in the local CKD management.4In an interview with Omnihealth Practice, Dr. Shea, Tat-Mingshared 2 clinical cases of patients aged >80 years with stage 3/4 CKD having multiple comorbidities, in whom dapagliflozin stabilized their estimated glomerular filtration rate (eGFR)and halted CKD progression. Dr. Shea also discussed the clinical data of dapagliflozin and provided practical tips to optimize treatment outcomes in the elderly CKD population.
A local case sharing: Dapagliflozin reduces proteinuria and slows disease progression in CKD patients
Dapagliflozin, a sodium-glucose co-transporter 2 (SGLT-2) inhibitor, has demonstrated improved renal outcomes in patients with chronic kidney disease (CKD), with or without type 2 diabetes (T2D), in the DAPA-CKD trial, providing an additional treatment option on top of angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) for better management of CKD patients.1 In an interview with Omnihealth Practice, Dr. Tam, Chun-Hay shared a clinical case of an 89-year-old patient with stage 3 CKD without T2D, in whom dapagliflozin reduced proteinuria and stabilized his renal function with good tolerability. He also discussed the clinical data of dapagliflozin and provided some practical tips on its use to optimize treatment outcomes.
New paradigms in hepatitis management to address treatment challenges and barriers to care
In a webinar organized by the Hong Kong Association for the Study of Liver Diseases (HKASLD), Professor Kim, Seung-Up and Dr. Wong, Yu-Jun Eugene introduced the new paradigms in viral hepatitis disease control. While Prof. Kim discussed some topics of hepatitis B virus (HBV) management, including the increased risk of kidney disease with long-term antiviral use and the appropriate first-line agents to mitigate this risk, Dr. Wong presented the challenges of hepatitis C virus (HCV) management and access to care, highlighting the efficacy and safety of the direct-acting antiviral (DAA) treatment of sofosbuvir/ velpatasvir (SOF/VEL) in HCV patients and the simplified treatment monitoring in reducing the healthcare burden.
Insightful experience: SGLT2i to treat heart failure with reduced ejection fraction
Heart failure (HF) is global pandemic affecting at least 26 million people worldwide in 2017 and has been increasing in prevalence.1 In 2020, HF plus other heart diseases caused an age-standardized death rate of 34.0 per 100,000 standard population in Hong Kong.2 Previously, patients with HF with reduced ejection fraction (HFrEF) were treated with a foundational triple therapy including β-blockers, renin-angiotensin system inhibitors [including angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs)] or angiotensin receptor-neprilysin inhibitors (ARNIs), as well as mineralocorticoid receptor antagonists (MRAs).3 With reference to the recent data supporting the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in patients with chronic HFrEF regardless of the diabetes status, it is noted that comprehensive diseasemodifying quadruple therapy has now become the new standard of care for HFrEF patients.4,5 In a recent interview with Omnihealth Practice, Professor Siu, Chung-Wah David shared his insights on the application of SGLT2i in HFrEF treatment.
Beyond diabetes: FDA now approves dapagliflozin for the treatment of chronic kidney disease
Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor that was initially approved in 2014 for the treatment of type 2 diabetes mellitus (T2DM) and subsequently for heart failure with reduced ejection fraction (HFrEF), has recently received yet another approved indication by the United St
What not to ignore when diabetes interacts with acute and chronic kidney diseases: A local case sharing
While they may not necessarily have a causal relationship, both chronic kidney disease (CKD) and diabetes mellitus (DM) have become increasingly more prevalent worldwide.1 As these conditions could be risk factors for developing acute kidney injury (AKI),2 CKD and DM must be carefully managed to pre
Advanced-stage Hodgkin lymphoma in an elderly patient: A case report highlighting the efficacy of brentuximab vedotin treatment
Hodgkin lymphoma (HL) is an aggressive hematological malignancy, with around 70 new cases being reported per year in Hong Kong.1 The incidence rate for HL among people aged 65 or above in Hong Kong is 1.6 per 100,000 persons.1