Background:
Cerebral blood flow (CBF) and susceptibility values reflect vascular and iron metabolism, providing mechanistic insights into conditions of health and disease. Non-dialysis patients with chronic kidney disease (CKD) show a cognitive decline, but the pathophysiological mechanisms underlying this remain unclear.
Methods:
Three-dimensional pseudo-continuous arterial spin labeling and quantitative susceptibility mapping were prospectively performed in 40 patients with stage 1â4 CKD (CKD 1â4), 47 non-dialysis patients with stage 5 CKD (CKD 5ND), and 44 healthy controls. Voxel-based global and regional analyses of CBF, susceptibility values, and vascular-susceptibility coupling were performed. Furthermore, the association between clinical performance and cerebral perfusion and iron deposition was analyzed.
Results:
For CBF, patients with CKD 5ND had higher normalized CBF in the hippocampus and thalamus than healthy controls. Patients with CKD 5ND had higher normalized CBF in the hippocampus and thalamus than those with CKD 1â4. The susceptibility values in the hippocampus and thalamus were lower in patients with CKD 5ND than in healthy controls. Patients with CKD 5ND had higher susceptibility value in the caudate nucleus than those with CKD 1â4. More importantly, patients with CKD 5ND had lower CBF-susceptibility coupling than healthy controls. Additionally, CBF and susceptibility values were significantly associated with clinical performance.
Conclusions:
Our findings demonstrate a new neuropathological mechanism in patients with CKD, which leads to regional changes in CBF-susceptibility coupling. These changes are related to cognitive decline, providing potential imaging markers for assessing clinical disability and cognitive decline in these patients.