Clinical Characteristics and Survival Among Patients with Kidney Failure Who Develop Parkinson Disease

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Background: Parkinson’s Disease (PaDi) and kidney failure commonly affect older individuals; each has independent negative impacts on survival; however, we lack a clear understanding of how these diseases interact when PaDi is diagnosed in patients on dialysis. Methods: In this USRDS analysis examining all patients initiating dialysis between 2009 and 2019, we identified patients developing PaDi after initiating dialysis (PaDi cohort), and compared them to the remainder (non-PD USRDS cohort), and a 1:3 ratio propensity score(PS)-matched control cohort. We used a 14-variable Cox-proportional hazard model to estimate the association of PaDi on survival. We used the interaction model to examine the differential influence of individual comorbidities on survival among the PD and PS-matched control cohort. Results: Of 781,723 initiating dialysis during the study period, 5,078 developed PaDi at 890 (interquartile range, IQR:373-1,476) days after initiating dialysis. PaDi cohort patients were older and had a higher representation of White race and male gender, and had a greater comorbidity burden, including cardiovascular disease and diabetes; insignificant differences remained between PaDi and PS-matched control cohort. Median (IQR) survival was 471 (395-548) days in PaDi cohort, 1,262(1,257-1,267) days in non-PaDi USRDS cohort, and 664(592-739) days in PS-matched control cohort, with PaDi having 43% higher risk of death (adjusted hazard ratio, aHR:1.43, 95% confidence interval, CI:1.36-1.50) compared to PS-matched control cohort (Figure). Secondary analyses showed that PaDi patients had 2-6-fold higher prevalence of PaDi-specific comorbidities, i.e., functional disability, depression, anxiety disorder, falls, aspiration pneumonia, and psychosis. Adjusting for these comorbidities revealed significant associations between the markers of PaDi severity and mortality(P<0.001), with PaDi continuing to have an significant residual association with survival (aHR:1.19; P<0.001). Conclusion: Patients on dialysis developing PaDi are older and have significantly higher mortality, in a large part, driven by PaDi-specific comorbidities. Through various secondary analyses, we aim to explain unique risk factors and therapeutic considerations for dialysis management and survival in this cohort.

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