Pattern of cerebral blood flow and cognition in patients undergoing chronic haemodialysis treatment

Fazekas, G.; Fazekas, Franz; Schmidt, Robert W.; Flooh, E.; Valetitsch, H.; Kapeller, Peter; Gj, Krejs

doi:10.1097/00006231-199607000-00011

Cited by 38 publications

(22 citation statements)

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“…We also found decreased ReHo in the frontal and parietal cortex, which was consistent with previous studies [1], [13]. Parietal cortex lesions are considered to be engaged in distinct attention functions such as attention shift, visuo-spatial attention, working memory, and supramodal control [40]–[42].…”

Section: Discussionsupporting

confidence: 92%

“…Positron emission tomography (PET) and single photon emission tomography (SPECT) are effective methods for investigating brain activity through observing changes in cerebral blood flow or cerebral metabolism [12]. Long-term hemodialysis patients without significant abnormality on neuropsychological tests showed hypo-metabolism or hypo-perfusion in the frontal cortex and thalamus [13]. Magnetic resonance spectroscopy (MRS) is ideally suited for biochemical changes in the brain and useful for monitoring of metabolic alterations [14].…”

Section: Introductionmentioning

confidence: 99%

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Altered Pattern of Spontaneous Brain Activity in the Patients with End-Stage Renal Disease: A Resting-State Functional MRI Study with Regional Homogeneity Analysis

Wen

et al. 2013

PLoS ONE

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PurposeTo investigate the pattern of spontaneous neural activity in patients with end-stage renal disease (ESRD) with and without neurocognitive dysfunction using resting-state functional magnetic resonance imaging (rs-fMRI) with a regional homogeneity (ReHo) algorithm.Materials and Methodsrs-fMRI data were acquired in 36 ESRD patients (minimal nephro-encephalopathy [MNE], n = 19, 13 male, 37±12.07 years; non-nephro-encephalopathy [non-NE], n = 17, 11 male, 38±12.13 years) and 20 healthy controls (13 male, 7 female, 36±10.27 years). Neuropsychological (number connection test type A [NCT-A], digit symbol test [DST]) and laboratory tests were performed in all patients. The Kendall's coefficient of concordance (KCC) was used to measure the regional homogeneity for each subject. The regional homogeneity maps were compared using ANOVA tests among MNE, non-NE, and healthy control groups and post hoc t -tests between each pair in a voxel-wise way. A multiple regression analysis was performed to evaluate the relationships between ReHo index and NCT-A, DST scores, serum creatinine and urea levels, disease and dialysis duration.ResultsCompared with healthy controls, both MNE and non-NE patients showed decreased ReHo in the multiple areas of bilateral frontal, parietal and temporal lobes. Compared with the non-NE, MNE patients showed decreased ReHo in the right inferior parietal lobe (IPL), medial frontal cortex (MFC) and left precuneus (PCu). The NCT-A scores and serum urea levels of ESRD patients negatively correlated with ReHo values in the frontal and parietal lobes, while DST scores positively correlated with ReHo values in the bilateral PCC/precuneus, MFC and inferior parietal lobe (IPL) (all P<0.05, AlphaSim corrected). No significant correlations were found between any regional ReHo values and disease duration, dialysis duration and serum creatinine values in ESRD patients (all P>0.05, AlphaSim corrected).ConclusionDiffused decreased ReHo values were found in both MNE and non-NE patients. The progressively decreased ReHo in the default mode network (DMN), frontal and parietal lobes might be trait-related in MNE. The ReHo analysis may be potentially valuable for elucidating neurocognitive abnormalities of ESRD patients and detecting the development from non-NE to MNE.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Altered Pattern of Spontaneous Brain Activity in the Patients with End-Stage Renal Disease: A Resting-State Functional MRI Study with Regional Homogeneity Analysis

Wen

et al. 2013

PLoS ONE

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“…Dialysis patients have a higher burden of cerebral atrophy and subclinical ischaemic white matter changes compared with the general population 15–17. Fazekas et al 18 also demonstrated reduced cerebral blood flow in the frontal region of the brain during haemodialysis. These changes though have not always correlated with cognitive findings 19…”

Section: Cognitive Impairment In Advanced Kidney Diseasementioning

confidence: 93%

Determinants of quality of life in advanced kidney disease: time to screen?

Iyasere

Brown

2014

Postgraduate Medical Journal

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The incidence of older patients with end stage renal disease is on the increase. This group of patients have multiple comorbidities and a high symptom burden. Dialysis can be life sustaining for such patients. But it is often at the expense of quality of life, which starts to decline early in the pathway of chronic kidney disease. Quality of life is also important to patients and is a major determinant in decisions regarding renal replacement. As a result, validated patient-reported outcome measures are increasingly used to assess quality of life in renal patients. Cognitive impairment, depression, malnutrition and function decline are non-renal determinants of quality of life and mortality. They are under-recognised in the renal population but are potentially treatable, if not preventable. This review article discusses aetio-pathogenesis, prevalence and impact of these four outcomes, advocating regular screening for early identification and management.

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“…Related to this observation, elevated CBF was apparent at a higher eGFR threshold in white matter (eGFR ,60 mL/min/1.73 m 2 ) than for total CBF (eGFR ,45 mL/min/1.73 m 2 ). Previous small studies have assessed CBF with SPECT in patients receiving hemodialysis, and have reported both higher 21,22 and lower 23 CBF compared to patients with normal kidney function. A recent population-based cohort study that utilized phase-contrast imaging to assess CBF found that lower eGFR was associated with lower CBF.…”

mentioning

confidence: 99%

Chronic kidney disease, cerebral blood flow, and white matter volume in hypertensive adults

et al. 2016

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Objective: To determine the relation between markers of kidney disease-estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR)-with cerebral blood flow (CBF) and white matter volume (WMV) in hypertensive adults. Methods:We used baseline data collected from 665 nondiabetic hypertensive adults aged $50 years participating in the Systolic Blood Pressure Intervention Trial (SPRINT). We used arterial spin labeling to measure CBF and structural 3T images to segment tissue into normal and abnormal WMV. We used quantile regression to estimate the association between eGFR and UACR with CBF and abnormal WMV, adjusting for sociodemographic and clinical characteristics.Results: There were 218 participants (33%) with eGFR ,60 mL/min/1.73 m 2 and 146 participants (22%) with UACR $30 mg/g. Reduced eGFR was independently associated with higher adjusted median CBF, but not with abnormal WMV. Conversely, in adjusted analyses, there was a linear independent association between UACR and larger abnormal WMV, but not with CBF. Compared to participants with neither marker of CKD (eGFR $60 mL/min/1.73 m 2 and UACR ,30 mg/g), median CBF was 5.03 mL/100 g/min higher (95% confidence interval [CI] 0.78, 9.29) and abnormal WMV was 0.63 cm 3 larger (95% CI 0.08, 1.17) among participants with both markers of CKD (eGFR ,60 mL/min/1.73 m 2 and UACR $30 mg/g).Conclusions: Among nondiabetic hypertensive adults, reduced eGFR was associated with higher CBF and higher UACR was associated with larger abnormal WMV. Neurology ® 2016;86:1208-1216 GLOSSARY ACE 5 angiotensin-converting enzyme; ASL 5 arterial spin labeling; CBF 5 cerebral blood flow; CI 5 confidence interval; CKD 5 chronic kidney disease; CVD 5 cardiovascular disease; eGFR 5 estimated glomerular filtration rate; FLAIR 5 fluidattenuated inversion recovery; GFR 5 glomerular filtration rate; IQR 5 interquartile range; ROI 5 region of interest; SPRINT 5 Systolic Blood Pressure Intervention Trial; UACR 5 urine albumin to creatinine ratio; WMV 5 white matter volume.Chronic kidney disease (CKD) affects 12% of US adults and is associated with an increased risk of stroke.

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Pattern of cerebral blood flow and cognition in patients undergoing chronic haemodialysis treatment

Cited by 38 publications

References 0 publications

Altered Pattern of Spontaneous Brain Activity in the Patients with End-Stage Renal Disease: A Resting-State Functional MRI Study with Regional Homogeneity Analysis

Altered Pattern of Spontaneous Brain Activity in the Patients with End-Stage Renal Disease: A Resting-State Functional MRI Study with Regional Homogeneity Analysis

Determinants of quality of life in advanced kidney disease: time to screen?

Chronic kidney disease, cerebral blood flow, and white matter volume in hypertensive adults

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