491
2020년 제 71차 대한내과학회 추계학술대회
￭S-448 ￭ Association of dementia risk and general anesthesia in patients
with chronic kidney disease
울산대학교병원 내과1, 한림대학교 생사학연구소2, 울산대학교병원 마취과3
백강현1, 유경돈1, 박경선1, 박종하1, 이종수1, 김태미2, 박은선3
Background/Aims: Patients with chronic kidney disease (CKD) were regarded as increasing the risk of cognitive dysfunction according to kidney function. However, little is known about the relation of in-traoperative aspect for CKD patients with general anesthesia.
Methods: A population-based prospective cohort study was conducted using the Korean National Health Insurance Service-National Sample Cohort database over 50 yrs, including CKD from Jan 2003 and Dec 2013. The primary outcome was the incidence of dementia using Korean Classification of Diseases (KCD) codes, and receipt of medication such as donepezil, rivastigmine, galanta-mine, and memantine. Time-varying Cox regression analysis was applied for risk factor analysis of incident dementia.
Results: We excluded 34 of the 7,989 patients with CKD who had already been diagnosed with demen-tia prior to surgery with general anesthesia. Among these patients, only 5,497 patients over 50 years of age were included in the final analysis (Figure 1). The 84 of the 1,676 participants of general anesthesia groups had developed newly dementia after surgery (5.0%). Of the 3,821 control groups that had CKD but did not have general anesthesia, 283 participants had present-ed incident dementia. In time-varying Cox regression analyses revealed that general anesthesia group did not increase the development of dementia in CKD patients, compare to control group (HR 1.053, 95% CI 0.819-1.353) after adjustment of age, sex, health security certification, history of depression, diabetes, hypertension, cerebrovascular disease, ischemic heart disease, quintile group for health care visit frequency and Charlson comorbidities score. Male sex, old age, history of de-pression and cerebrovascular disease were an independent risk factor of incident dementia in CKD patients, irrespective of anesthetic methods.
Conclusions: In CKD patients, general anesthesia operation did not increase the risk of incident dementia. Subgroup analysis was warranted, especially in patients with advanced CKD, including dialysis.
