Abstract
Background and Purpose: End-stage renal disease (ESRD) results in extensive white matter abnormalities, but the specific damage segment cannot be identified. This study aimed to determine the segmental abnormalities of white matter microstructure in ESRD and its relationship with cognitive and renal function indicators.Methods: Eighteen ESRD patients and 19 healthy controls (HCs) were prospectively recruited. All participants underwent DTI and clinical assessments. Automatic fiber quantification (AFQ) was applied to generate bundle profiles along 16 main white matter tracts. We compared the DTI parameters between groups. Besides, we used partial correlation and multiple linear regression analyses to explore the associations between white matter integrity and cognitive performance as well as renal function indicators.Results: In the global tract level, compared to HCs, ESRD patients had greater MD, AD, and RD values and lower FA value in several fibers (P < 0.05, FDR correction). In the point-wise level, extensive damage existed in specific locations of different fiber tracts, particularly in the left hemisphere (P < 0.05, FDR correction). Among these tracts, the mean AD values of the left cingulum cingulate correlated negatively with MoCA score. Urea and UA level were independent predictors of the AD value of superior component of the left corticospinal. Besides, urea level was the independent predictors of mean MD value of left anterior thalamic radiation (ATR).Conclusion: White matter fiber tract damage in ESRD patients may be characterized by abnormalities in its specific location, especially in the left hemisphere. Aberrational specific located fibers were related to cognitive impairment and renal dysfunction.
Highlights
Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function
Fractional Anisotropy For the whole global tract, compared to HCs, lower mean flip angle (FA) values were in the End-stage renal disease (ESRD) patients in the right anterior thalamic radiation (ATR), right cingulum cingulate (CC), bilateral inferior fronto-occipital fasciculus (IFOF), bilateral inferior longitudinal fasciculus (ILF), and callosum forceps minor (P < 0.05, false discovery rate (FDR) correction, Supplementary Table 1 and Figure 2)
We found the following points: (1) ESRD patients had extensive microstructure fragility of white matter fiber bundles, especially on the left side of the hemisphere; (2) changes of white matter microstructure might occur along the entire white matter fiber bundle, and at some specific fiber segments; and (3) the point-wise level analysis was more sensitive than fiber tract level analysis and white matter fiber damage might be associated with clinical symptoms and cognitive function
Summary
Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function. End-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD), which is defined as an eGFR of less than 15 ml/min/1.73 m2. ESRD patients require renal replacement therapy via maintenance dialysis or kidney transplantation to maintain life (National Kidney Foundation, 2002; Romagnani et al, 2017). CKD induces a series of pathophysiological processes which in turn affect the structural and functional integrity of the brain, which is more pronounced in ESRD patients (Lu et al, 2015). ESRD patients are often accompanied by cognitive decline. End-stage renal disease (ESRD) results in extensive white matter abnormalities, but the specific damage segment cannot be identified. This study aimed to determine the segmental abnormalities of white matter microstructure in ESRD and its relationship with cognitive and renal function indicators
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
