Research Paper Volume 11, Issue 17 pp 6941—6950

Erythropoietin prevents dementia in hemodialysis patients: a nationwide population-based study

Peir-Haur Hung1,2, , Chih-Ching Yeh3,4, , Fung-Chang Sung5,6, , Chih-Yen Hsiao1, , Chih-Hsin Muo5, , Kuan-Yu Hung7, , Kuen-Jer Tsai8,9, ,

  • 1 Department of Internal Medicine, Ditmanson Medical Foundation Chia-yi Christian Hospital, Chia-yi, Taiwan
  • 2 Department of Applied Life Science and Health, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
  • 3 School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
  • 4 Department of Public Health, China Medical University, Taichung, Taiwan
  • 5 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
  • 6 Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
  • 7 Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
  • 8 Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 9 Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

Received: May 7, 2019       Accepted: August 16, 2019       Published: September 5, 2019
How to Cite

Copyright © 2019 Hung et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Erythropoietic medications such as including erythropoietin (EPO) are known to be neuroprotective and to correlate with improved cognitive functions. However, it is not known whether supplementation with EPO reduces the risk of dementia in end-stage renal disease (ESRD) patients receiving hemodialysis (HD). Here, we determined whether EPO levels correlate with the incidence of different dementia subtypes, including Alzheimer’s disease (AD), vascular dementia (VaD), and unspecified dementia (UnD), and whether such associations vary with annual cumulatively defined daily doses (DDDs) of EPO for ESRD patients receiving HD. This retrospective study included data from 43,906 adult ESRD patients who received HD between 1999 and 2010. Using hazard ratios and Cox regression models, we found that patients receiving EPO had a 39% lower risk of general dementia than those in the non-EPO group. Similarly, the risks of VaD and UnD was lower for patients in the EPO cohort. The risk of dementia was further reduced in HD patients treated with EPO in combination with iron. Our results suggest that the use of EPO medications in HD patients is associated with a reduced risk of VaD and UnD, but not AD, regardless of whether EPO is used alone or in combination with iron.


Aβ: amyloid beta; AD: Alzheimer’s disease; AF: atrial fibrillation; BNHI: Bureau of NHI; CI: confidence interval; DDD: Defined daily dose; EPO: erythropoieti; ESRD: end-stage renal disease; HD: hemodialysis; HR: hazard ratio; NHI: National Health Insurance; TSAT: transferrin saturation; UnD: unspecified dementia; VaD: vascular dementia.