The relation between brain MRI findings and blood manganese levels in renal transplantation, hemodialysis, and peritoneal dialysis patients

Abstract

Various factors can affect blood and tissue levels of trace elements in patients with end-stage renal disease. There are a few studies showing hyperintensity of basal ganglia associated with manganese deposition in hemodialysis (HD) patients. The present study aimed to investigate the intensity changes as markers of manganese deposition in the basal ganglia and to demonstrate their association with blood manganese levels using ICP/MS technique in HD, peritoneal dialysis (PD), and renal transplant patients. The study included 20 HD, 20 PD, 20 renal transplant patients, and 20 healthy controls. Blood manganese levels were obtained, and cranial magnetic resonance images were evaluated for basal ganglia hyperintensity. Blood manganese levels were similar across all study groups (p=0.308), whereas symmetric basal ganglia hyperintensity indicating manganese deposition was detected only in HD patients (p=<0.001). There was a significant relationship between manganese deposition and duration of dialysis (p=0.05). Imaging findings suggesting manganese deposition in the basal ganglia being present only in HD patients suggest that manganese deposition could be caused by the hemodialysis method itself rather than uremia and renal failure. Further studies are required in this regard, as previous studies have not clearly identified the mechanisms by which hemodialysis causes these changes.