Longer dialysis times are associated with a lower chance of dementia among chronic hemodialysis patients.

Dementia is common in chronic hemodialysis (HD) patients and is associated with a higher mortality. Factors associated with dementia in HD patients are not clear. We investigated factors associated with early dementia in HD patients. Chronic HD patients of 27 hemodialysis centers were enrolled in 2013. Early dementia was identified using the AD8 assessment. Factors associated with early dementia were analyzed using logistic regression. A total of 1617 chronic HD patients including 820 males and 797 females, aged 63.3 ± 13 years, dialyzed for 4 (1.8-8.4) years were analyzed. Early dementia was identified in 414 (25.6%) of the patients. Longer HD times were associated with a lower chance of dementia (P = 0.032), with an adjusted odds ratio (OR) of 0.522 (95% confidence interval [CI]: 0.270-0.969) for every one more hour of HD. Patient's age (OR: 1.587, 95% CI: 1.406-1.791, P < 0.001), body mass index (OR: 0.958, 95% CI: 0.921-0.996, P = 0.031), cerebrovascular accident (OR: 1.480, 95% CI: 1.000-2.188), diabetes (OR: 1.894, 95% CI: 1.390-2.581, P < 0.001), and serum albumin (OR: 0.376, 95 % CI: 0.256-0.553, P < 0.001) were independently linked to early dementia. Short hemodialysis times are associated with early dementia in a chronic hemodialysis population with a quarter of patients having early dementia. Patients' age, nutrition status and comorbidity are independently linked to early dementia.

Permanent renal loss following tumor necrosis factor α antagonists for arthritis.

Tumor necrosis factor alpha (TNF-alpha) antagonists are now widely used in the treatment of aggressive rheumatoid arthritis and are generally well tolerated. Although rare, they could induce systemic lupus erythematosus, glomerulonephritis, and antineutrophil cytoplasmic antibody associated systemic vasculitis. Tumor necrosis factor alpha antagonists associated glomerulonephritis usually subsides after discontinuation of the therapy and subsequent initiation of corticosteroids and immunosuppressive agents. Here we describe crescentic glomerulonephritis progression to end-stage renal disease in a patient following two doses of TNF-alpha antagonists for the treatment of reactive arthritis. To our knowledge, dialysis dependent permanent renal loss after TNF-alpha antagonists has not yet been reported. We suggest the renal function should be closely monitored in patients treated with TNF-alpha antagonists by rheumatologists.