Malnutrition-inflammation is a risk factor for cerebral small vessel diseases and cognitive decline in peritoneal dialysis patients: a cross-sectional observational study

Ke Zheng,Sagar Uday Nigwekar,Haiyun Wang,Kai Luo,Xuemei Li,Bo Hou,Mingxi Li,Yicheng Zhu,Qun Xu,Jing Yuan,Liying Cui,Feng Feng,Limeng Chen,Hui You

doi:10.1186/s12882-017-0777-1

Abstract

BackgroundChronic kidney disease patients have an increased prevalence of subclinical cerebrovascular diseases. Dialysis patients have severe vascular diseases burden. The cerebral small vessel diseases (CSVD) are difficult to find by clinical assessment. The evaluation of CVSD needs MRI. Cognitive impairment is a consequence of CVSD which is diagnosed by cognitive testing. These limited the study of CVSD and cognitive function in dialysis patients. Peritoneal dialysis (PD) patients are minority of dialysis population. We know even fewer about the CVSD in this special population.MethodsIn this cross-sectional study, we enrolled 72 PD patients who received care at the Peking Union Medical College hospital peritoneal dialysis center. CSVD were assessed by brain MR images. Cognitive function was evaluated with the Chinese version of the MMSE and MoCA.ResultsIn our PD patients, the brain MRI showed the prevalence different signs of CSVD were: lacunar infarcts 38.9%, microbleeds 36.1%, abnormal brain white matter hyperintensities (WMHs) 48.6%, and intracerebral hemorrhage 4.2%. 25% and 86.8%of our patients could be diagnosed as cognitive impairment, according to the MMSE and MoCA test, respectively. nPCR was lower in patients with a lacunar infarct or intracerebral hemorrhage, and relative to the MMSA/MoCA score; hsCRP was higher in patients with lacunar infarct or abnormal WMHs and negative relative to the MMSA/MoCA score. In logistic regression analyses, nPCR was an independent risk factor for lacunar infarcts and impaired cognitive function. The presence of lacunar infarct was an independent risk factor for cognitive function decline.ConclusionWe demonstrated a high prevalence of CSVD and cognitive impairment in our PD patients. Lacunar infarct was the main kind of CVSD responsible for PD patients cognitive function decline. Our novel observation also revealed an association between malnutrition-inflammation and CSVD.

Highlights

Chronic kidney disease patients have an increased prevalence of subclinical cerebrovascular diseases
In Peritoneal dialysis (PD) patients, we found a high prevalence of cerebral small vessel diseases (CSVD), including lacunar infarct in 38.9%, cerebral microbleeds in 36.1%, abnormal white matter magnetic resonance hyperintensities (WMHs) in 48.6%, and intracerebral hemorrhage in 4.2%
We demonstrated a high prevalence of CSVD and cognitive impairment in PD patients

Summary

Introduction

Chronic kidney disease patients have an increased prevalence of subclinical cerebrovascular diseases. Cognitive impairment is a consequence of CVSD which is diagnosed by cognitive testing These limited the study of CVSD and cognitive function in dialysis patients. CKD patients have an increased prevalence of subclinical cerebrovascular diseases, including silent brain infarcts (SBIs), white matter magnetic resonance hyperintensities (WMHs), and cerebral microbleeds [1]. WMHs and microbleeds are signs of cerebral small vessel disease (CSVD). CSVDs are difficult to detect with clinical evaluation in our daily practice For such subclinical lesions, we need brain magnetic resonance (MR) images to identify them. We need brain magnetic resonance (MR) images to identify them This limits the study of CSVD in dialysis population. PD patients are minority of dialysis population in most of western countries For this group of patients, there are very limited data about their CSVD

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Discussion

Conclusion