Abstract
BackgroundCognitive impairment is a well-defined complication of chronic kidney disease (CKD), but the neural mechanisms are largely unknown.ObjectivesThe study aimed to assess white matter (WM) microstructure changes and their relationship with cognitive impairment development during CKD progression.MethodsDiffusion tensor imaging (DTI) datasets were acquired from 38 patients with CKD (19 patients were at stage 3; 19 patients were at stage 4) and 22 healthy controls (HCs). Tract-based spatial statistics (TBSS) was implemented to assess the differences in WM integrity among the three groups. The associations between abnormal WM integrity and clinical indicators (digit symbol test scores, the type A number connection test scores, hemoglobin, serum urea, serum creatinine, serum calcium, and serum potassium levels) were also computed.ResultsCompared with patients with CKD at stage 3 and HCs, patients with CKD at stage 4 showed significantly lower fractional anisotropy (FA) and higher mean diffusivity (MD) in the corpus callosum (CC), anterior thalamic radiation, inferior fronto-occipital fasciculus, and inferior longitudinal fasciculus. Correlation analysis showed that the MD in the genu of CC was negatively associated with the digit symbol test scores (r = -0.61, p = 0.01), and the FA in the left anterior thalamic radiation was positively associated with the level of serum calcium (r = 0.58, p = 0.01).ConclusionPatients with non-end-stage CKD have multiple abnormalities in WM regions. DTI metrics change with the progression of CKD and are primarily associated with cognitive impairment. The reduced integrity of WM tracts may be related to a low level of blood calcium.
Highlights
Chronic kidney disease (CKD) is defined as a glomerular filtration rate of less than 60 ml/min/1.73 m2 or increased urinary albumin excretion for no less than 3 months
Our study observed the difference in WM integrity between CKD3 and CKD4 patients but did not find significant differences in the scores of neuropsychological tests on CKD3 and CKD4 groups, probably because the limited cognitive tests used in this study only provide partial changes in cognitive function, which made the study of cognitive function limited
Our findings showed degeneration of the inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, and superior longitudinal fasciculus in the CKD4 group compared to the CKD3 group and Healthy controls (HCs)
Summary
Chronic kidney disease (CKD) is defined as a glomerular filtration rate of less than 60 ml/min/1.73 m2 or increased urinary albumin excretion for no less than 3 months. Cognitive impairment is a well-defined complication of CKD (Bugnicourt et al, 2013). By using cognitive function testing, studies have found that patients with stage 3 or 4 CKD have impaired processing speed, short-term memory, recall memory, and sequencing function compared with healthy people (Berger et al, 2016), which suggests that neurocognitive deficits are already present in the non-end-stage of CKD. Recent structural MRI studies have found abnormal brain volumes in patients with CKD (Murea et al, 2015; Freedman et al, 2017; Hartung et al, 2018), but it remains unclear whether specific brain changes associated with cognitive impairment will occur in the non-endstage of CKD. Cognitive impairment is a well-defined complication of chronic kidney disease (CKD), but the neural mechanisms are largely unknown
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