Physical activity and the risk of dementia in end-stage renal disease patients undergoing hemodialysis: a nationwide population-based study.

Abstract

Background: Several studies have reported that dementia has a high prevalence in end-stage kidney disease (ESKD) patients. However, the relationship between physical activity (PA) and the risk of dementia has not been elucidated for hemodialysis patients.

Methods: A total of 11,724 patients aged ≥40 years who started hemodialysis between 2012 and 2017 were identified from the Korean National Health Insurance Service database. Individuals with PA were defined as meeting the following criteria: 1) 1 or more days per week of vigorous activity of at least 20 minutes per day or 2) 1 or more days per week of moderate-intensity activity of at least 30 minutes per day. The occurrence of dementia was monitored until the end of 2018 based on specific codes of International Classification of Diseases, 10th Revision.

Results: During the 1.9-year follow-up, 489 hemodialysis patients developed dementia. PA was associated with a lower risk of any dementia (hazard ratio, 0.686; 95% confidence interval, 0.553-0.85) even after adjusting for confounding factors. The risk of dementia was lower in hemodialysis patients with PA when the risk of Alzheimer disease was analyzed separately, but vascular dementia was not. PA was associated with a lower risk of dementia in a dose-dependent manner when stratified by the energy expenditure level. In subgroup analyses stratified by age, sex, income level, smoking, drinking, diabetes mellitus, hypertension, dyslipidemia, and cerebrovascular accident, the risk of dementia tended to be lower in hemodialysis patients with PA than in those without PA.

Conclusion: PA was associated with a lower risk of dementia development in ESKD patients undergoing hemodialysis.