Predominant gray matter volume loss in patients with end-stage renal disease: a voxel-based morphometry study

Abstract

To investigate the pattern of brain volume changes in patients with end-stage renal disease (ESRD) using voxel-based morphometry (VBM) and correlation with clinical and neuropsychological (NP) tests. Fifty seven ESRD patients with no anatomical abnormalities in conventional magnetic resonance imaging [24 patients with abnormal NP scores, 16 male, 39 ± 12 years; 33 patients with normal NP scores, 23 male, 35 ± 9.7 years] and 22 age- and gender-matched healthy controls (14 male, 36 ± 10.1 years) were recruited in this study. Results from VBM analysis were analyzed with ANOVA test among 3 groups (controls, minimal nephro-encephalopathy group, non-nephro-encephalopathy group). Multiple linear regression analysis was used to investigate the effect of serum urea and creatinine, and dialysis duration on the brain volumes in ESRD patients. Correlation analysis was performed to investigate the association between NP scores with the brain volumes in ESRD patients. Compared with healthy controls, ESRD patients showed diffusely decreased gray matter volume that further decreased in the presence of encephalopathy. Multiple linear regression results showed that serum urea was negatively associated with changes in gray matter volume in many regions, while dialysis duration was negatively associated with some white matter volume changes (All P < 0.05, AlphaSim correction). NP scores correlated with some decreased gray matter volume in ESRD patients (All P < 0.05, AlphaSim correction). No correlation was found between white matter volume and any NP test scores in ESRD patients. This study found predominantly decreased gray matter volume in ESRD patients, which was associated with neurocognitive dysfunction. Serum urea level may be a risk factor for decreased gray matter in ESRD patients.

Abnormal Intrinsic Brain Activity Patterns in Patients with End-Stage Renal Disease Undergoing Peritoneal Dialysis: A Resting-State Functional MR Imaging Study

“…Authors of these studies did not investigate the effect of the specific dialysis modality on spontaneous brain activity in patients with ESRD, because they included patients undergoing hemodialysis and PD and those not undergoing dialysis. In addition, most previous studies have been focused on abnormal gray and white brain matter structures (16,(22)(23)(24)(25)(26). Several studies (2,7,8) included patients with ESRD undergoing hemodialysis and PD, which can have a confounding effect on the study results.…”

Altered long- and short-range functional connectivity in the patients with end-stage renal disease: a resting-state functional MRI study

“…In addition, some brain regions showed increased FCD in patients with ESRD (including temporal lobe, caudate, and orbitofrontal cortex), which might be attributed to brain functional plasticity or compensation. This finding was partially supported by the voxel-based morphometry study (Zhang et al 2013), in which increased gray matter volume in the right caudate in patients with ESRD was found. However, the exact functional relevance of the increased FCDs in these areas remains unclear.…”

“…One positron emission tomography study (Kanai et al 2001) claimed that cerebral oxygen metabolism of cerebral cortex, especially in frontal lobe, decreased dramatically in patients with chronic kidney disease. Zhang et al (Zhang et al 2013) found diffused gray matter volume loss (fontal, occipital, parietal and temporal cortex) in patients with ESRD by using a voxel-based morphometry method. Besides, the serum creatinine showed negative correlation with long-range FCD in bilateral middle frontal gyri and inferior frontal gyri.…”

“…Moreover, these ESRD patients without overt encephalopathy were subdivided into minimal nephrotic encephalopathy (MNE) group and non-nephro-encephalopathy (non-NE) group according to the test results of NCT-A and DST. MNE is diagnosed if the scores of at least one test (NCT-A or DST) were more than 2 standard deviations of the mean value for the age-matched healthy controls (Zhang et al 2013;Ni et al 2014). According to this definition, 21 patients were rated as MNE (14 male and 7 female), while 25 patients as non-NE (16 male and 9 female).…”

“…Neuroimaging has played a vital role in uncovering this underlying mechanism (Fazekas et al 1996;Geissler et al 1995;Kanai et al 2001;Kong et al 2014;Prohovnik et al 2007;Zhang et al 2013). Especially, resting-state fMRI (rsfMRI) has attracted more attention as a powerful tool to study brain activity in patients at resting state (Snyder and Raichle 2012).…”