Abstract: FR-PO436
Parkinson Disease and ESKD: Understanding Phenotypic Characteristics and Their Impact on Survival
Session Information
- Hemodialysis Epidemiology and Outcomes
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Parmar, Cydney El Cid, University of Florida, Gainesville, Florida, United States
- Scheiffele, Grant D., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Senthil, Nandita, University of Florida, Gainesville, Florida, United States
- Fischer, Jonathan, University of Florida, Gainesville, Florida, United States
- Wagle Shukla, Aparna, University of Florida, Gainesville, Florida, United States
- Shukla, Ashutosh M., University of Florida, Gainesville, Florida, United States
Background
Similar to end-stage kidney disease (ESKD), Parkinson’s disease is a major chronic disease affecting older individuals with a negative impact on the quality of life and survival. While there is an emerging literature on the brain-kidney axis, the clinical phenotype of patients with Parkinson’s disease initiating dialysis and their overall survival prospects have never been investigated.
Methods
We identified all incident ESKD patients initiating dialysis between 2009 and 2019 from the United States Renal Database System. Of these, we isolated Parkinson’s disease patients using ICD 9 and -10 codes. We used a random forest method to generate propensity scores and created a 1:5-matched non-Parkinson’s Disease control cohort. We used the Cox proportional hazards model to conduct a survival analysis.
Results
Of the 1,271,443 eligible patients during the study period, 5,462 had Parkinson’s disease at incident ESKD. These patients were significantly older (76.1±8.7 vs. 63.6±14.8 years), had higher functional limitations (43.4% vs. 17.4%), and had a burden of comorbidities such as heart failure (38.6% vs. 29.8%), atherosclerotic disease (37.8% vs. 27.5%), depression (37.0% vs. 11.8%), and had a lower incident of home dialysis use (4.5% vs. 9.5%). Median survival was significantly lower in Parkinson’s disease cohort (527 days, IQR: 170 - 1153), compared to the propensity-matched non-Parkinson’s disease control cohort (562 days, IQR: 166-1227) with an adjusted hazard ratio for death of 1.15 (1.11 - 1.18). Asian race (0.67, 0.62 - 0.72) and females (0.93, 0.90 – 0.93), and use of peritoneal dialysis (0.86, 0.81 – 0.91) were associated with improved survivals, whereas heart failure (1.26, 1.22 – 1.29), obstructive pulmonary disease (1.23, 1.19 – 1.27), and functional disability (1.44, 1.40 – 1.47) were associated with poorer survivals.
Conclusion
Incident ESKD patients with a preexisting diagnosis of Parkinson's disease are older, have higher comorbidity burden and functional limitations, and have worse survival. More pragmatic analyses accounting for quality of life are needed to understand better the benefits and risks of Parkinson’s disease patients initiating dialysis.
Funding
- Veterans Affairs Support