Abstract
BackgroundThe pathophysiology of neurological dysfunction in severe chronic kidney disease (CKD) in children and young adults is largely unknown. We aimed to investigate brain volumes and white matter integrity in this population and explore brain structure under different treatment modalities.MethodsThis cross-sectional study includes 24 patients with severe CKD (eGFR < 30) aged 8–30 years (median = 18.5, range = 9.1–30.5) on different therapy modalities (pre-dialysis, n = 7; dialysis, n = 7; transplanted, n = 10) and 21 healthy controls matched for age, sex, and parental educational level. Neuroimaging targeted brain volume using volumetric analysis on T1 scans and white matter integrity with tract-based spatial statistics and voxel-wise regression on diffusion tensor imaging (DTI) data.ResultsCKD patients had lower white matter integrity in a widespread cluster of primarily distal white matter tracts compared to healthy controls. Furthermore, CKD patients had smaller volume of the nucleus accumbens relative to healthy controls, while no evidence was found for abnormal volumes of gray and white matter or other subcortical structures. Longer time since successful transplantation was related to lower white matter integrity. Exploratory analyses comparing treatment subgroups suggest lower white matter integrity and smaller volume of the nucleus accumbens in dialysis and transplanted patients relative to healthy controls.ConclusionsYoung CKD patients seem at risk for widespread disruption of white matter integrity and to some extent smaller subcortical volume (i.e., nucleus accumbens). Especially patients on dialysis therapy and patients who received a kidney transplant may be at risk for disruption of white matter integrity and smaller volume of the nucleus accumbens.Graphical abstract
Highlights
Severe chronic kidney disease (CKD) in children and young adults impairs neurocognitive and psychosocial development, characterized by behavioral, social, learning, and vocational problems [1,2,3,4,5,6,7,8]
Age at severe CKD diagnosis was significantly higher in the dialysis group than in the transplanted group (p = 0.015, d = 1.41)
This study suggests that young patients with severe CKD are at risk of structural brain abnormalities, as detected on magnetic resonance imaging (MRI) by showing widespread abnormality of diffusion tensor imaging (DTI) parameters in the white matter
Summary
Severe chronic kidney disease (CKD) in children and young adults impairs neurocognitive and psychosocial development, characterized by behavioral, social, learning, and vocational problems [1,2,3,4,5,6,7,8]. Studies on the pathophysiology of neurological dysfunction in adults with severe CKD reported smaller brain volumes on magnetic resonance imaging (MRI) scans, indicative of brain atrophy [15,16,17,18,19,20,21,22]. Exploratory analyses comparing treatment subgroups suggest lower white matter integrity and smaller volume of the nucleus accumbens in dialysis and transplanted patients relative to healthy controls. Patients on dialysis therapy and patients who received a kidney transplant may be at risk for disruption of white matter integrity and smaller volume of the nucleus accumbens
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