Abstract
This study aimed to explore gray matter volume (GMV) changes in patients undergoing hemodialysis and assess the clinical risk factors associated with GMV changes and the relationship between GMV changes and neuropsychologic test results. Eighty-eight hemodialysis patients and 76 healthy controls (HCs) were recruited in this study. Fifty patients underwent follow-up examinations (follow-up duration: 1.75 ± 0.55 years), including magnetic resonance imaging, blood biochemical, and neuropsychologic testing. Changes in GMV between the patients and HCs were assessed. Longitudinal GMV changes were also explored in the patients. The clinical risk factors associated with longitudinal GMV changes and the correlations between longitudinal GMV changes and neuropsychologic test results were analyzed in the patients. Patients undergoing hemodialysis had diffusely decreased GMV compared with HCs (with age, sex, and total intracranial volume [TIV] as covariates, P<0.001, voxel-wise threshold false discovery rate [FDR] corrected). Compared with patients at baseline, regional decreased GMV were found in patients at follow-up (with age and TIV as covariates, P<0.05, voxel-wise threshold FDR corrected). Increased serum urea concentrations, parathyroid hormone levels, and hemodialysis duration were independent risk factors for decreased GMV in patients undergoing hemodialysis (all P<0.05, FDR corrected). Patients undergoing hemodialysis had lower mini-mental state examination (MMSE) (27[26, 29]) and Montreal cognitive assessment (MoCA) (22[19.5, 24.0]) scores than those of the HCs (30[29, 30] and 28[26.9, 29]) (all P<0.05). The MMSE scores of the patients at follow-up (26[25, 28.5]) were lower than those of patients at baseline (28[25, 29.5]) (P=0.02). The decreased left caudate volumes were positively correlated with reduced MMSE scores in hemodialysis patients (rs=0.437, P=0.033). Patients undergoing hemodialysis had noticeable GM atrophy over time, related to cognitive impairments.
Highlights
Kidney failure is defined as severe and irreversible kidney function impairment with an estimated glomerular filtration rate of < 15 mL/min/1.73 m2 (GRF category G5)[1]
We hypothesized that the process of hemodialysis may cause the aggravation of brain atrophy, which correlated with cognitive impairment
The purpose of this study was to investigate: 1) the brain volume changes in hemodialysis patients by cross-sectional and longitudinal MRI examinations using the CAT12 toolbox; 2) the clinical risk factors for the gray matter volume (GMV) changes; and 3) the correlations between brain volumes changes and cognitive function changes
Summary
Kidney failure is defined as severe and irreversible kidney function impairment with an estimated glomerular filtration rate of < 15 mL/min/1.73 m2 (GRF category G5)[1]. Hemodialysis has been an effectively and widely used treatment for kidney failure, it can often cause central nervous system complications, including cerebrovascular diseases[2], leukoencephalopathy[3], and cognitive impairment[4]. MR techniques have played an important role in the early diagnosis of central nervous systems complications in hemodialysis patients These techniques included resting-state functional MR imaging[7], diffusion tensor imaging (DTI)[8], arterial spin labeling (ASL)[9], magnetic resonance spectroscopy (MRS)[10], and susceptibility weighted imaging (SWI)[11]. Voxel-based morphometry (VBM) has been widely used to detect microstructure changes in patients with kidney failure[15], hemodialysis[16,17], and chronic kidney disease (CKD)[18] All of these studies found gray matter (GM) and white matter (WM) atrophy. Few studies explored the effect of only regular hemodialysis therapy on the cerebral structures
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