Cognitive Impairment and Structural Neuroimaging Abnormalities Among Patients with Chronic Kidney Disease

Abstract

Background/Aims: Cognitive impairment and abnormal structural neuroimaging is common in chronic kidney disease patients. We aimed to explore its association with dialysis modality and the relationship between cognitive impairment and abnormal structural neuroimaging. Methods: Sixty peritoneal dialysis patients and 30 hemodialysis and 30 non-dialyzed stage 3-5 chronic kidney disease patients without history of stroke were enrolled for the study. Participants were matched for age, gender, education, diabetes status, and dialysis duration (if appropriate). Cognitive functions were measured using a battery of recognized instruments. Brain features were examined with 3-dimensional magnetic resonance imaging. Results: Cognitive impairment was significantly more severe in dialysis patients than in non-dialyzed patients. The global and specific cognitive function were not significantly different between patients on peritoneal dialysis and hemodialysis. Hemodialysis patients had more severe white matter hyperintensity, sulcal and ventricular atrophy, and SVIs than other patients. In all groups, higher white matter grade, ventricular grade, and hippocampal atrophy were significantly associated with global cognitive impairment, with hazard ratios of 1.80 (1.22-2.64), 1.67 (1.09-2.57), and 2.49 (1.07-5.77), respectively. White matter grade was also significantly associated with delayed memory (hazard ratio 1.63; 1.12-2.39). Conclusion: Dialysis modality showed no association with cognitive impairment, although hemodialysis patients had more severe neuroimaging abnormalities. For the whole group, white matter hyperintensity, and ventricular and hippocampal atrophy, were independently associated with global cognitive impairment in chronic kidney disease patients.

Executive function in end-stage renal disease: Acute effects of hemodialysis and associations with clinical factors

“…The third objective was to analyze associations between EF performance and clinical and biochemical variables [27]. Decision-making performance (IGT) was positively associated with the total number of months previously transplanted.…”

Cerebral ischemia during hemodialysis—finding the signal in the noise

“…Injury to the brain can be assessed either by radiological methods, which provide largely structural information, or validated neurocognitive tests, which provide (arguably more important) functional information . Some but not all observational studies have suggested that patients who undergo maintenance peritoneal rather than hemodialysis have a slower decline in cognitive function, or fewer abnormalities on brain magnetic resonance imaging (MRI) . Increasing hemodialysis vintage has been associated with reductions in baseline cerebral blood flow, frontal lobe oxygenation and cognitive performance, as well as a greater burden of white matter abnormalities on MRI, particularly subtle changes on diffuser tensor imaging (DTI) .…”

“…18 Some but not all observational studies have suggested that patients who undergo maintenance peritoneal rather than hemodialysis have a slower decline in cognitive function, or fewer abnormalities on brain magnetic resonance imaging (MRI). 19,20 Increasing hemodialysis vintage has been associated with reductions in baseline cerebral blood flow, frontal lobe oxygenation and cognitive performance, as well as a greater burden of white matter abnormalities on MRI, particularly subtle changes on diffuser tensor imaging (DTI). [21][22][23] The potential for confounding in these studies is considerable, not least by time and treatment indication.…”

Structural network topology correlates to cognitive impairment and iPTH level in End-stage renal disease patients with peritoneal dialysis

“…Neuroimaging has been established as a reliable tool for assessing the neuropathologic mechanisms of cognitive impairment in ESRD patients [13,14]. Resting-state functional magnetic resonance imaging (rs-fMRI) showed that ESRD patients have lower ALFF values and abnormal brain functional connectivity in default mode network (DMN) regions when compared with healthy controls [15].…”