Widespread White Matter Alterations in Patients with End-Stage Renal Disease: A Voxelwise Diffusion Tensor Imaging Study

Abstract

BACKGROUND AND PURPOSE:ESRD results in excessive accumulation of urea and toxic metabolites. Hemodialysis is usually performed to maintain health in patients with ESRD; however, it may cause silent white matter alterations in the earlier stages. Hence, this study aimed to perform voxelwise diffusion tensor analysis for global detection of subtle white matter alterations in patients with ESRD.

Brain Default Mode Network Changes after Renal Transplantation: A Diffusion-Tensor Imaging and Resting-State Functional MR Imaging Study

“…Results of prior studies (23,(27)(28)(29) have shown that analysis of functional connectivity determined by measuring blood oxygenation level-dependent fluctuations is regarded to be more flexible than analysis of structural connectivity, which is the substrate of functional connectivity. These imaging findings are supported by neuropsychologic results in our study and prior studies (9)(10)(11)(12)(13). We found that neuropsychologic results correlated with change in temporal correlation coefficients of the fiber bundles connecting the PCC and with the change in digit symbol test scores (r = 0.533, P = .013) (Fig 4c).…”

“…Diffusion-tensor imaging (DTI) studies showed that patients with ESRD have lower fractional anisotropy and increased mean diffusivity values in all white matter regions when compared with patients in a healthy control group. These results positively correlated with neuropsychologic scores (13)(14)(15)(16). In recent studies (17)(18)(19)(20) of resting-state functional MR imaging, investigators have shown abnormal brain functional connectivity, particularly in the default mode network (DMN), in patients with ESRD.…”

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.…”

Randomized Clinical Trial of Dialysate Cooling and Effects on Brain White Matter

“…24,25 These studies reported decreased FA and increased mean diffusivity and RD in patients on HD compared with age-matched controls, indicating established WM damage. However, the lack of a longitudinal design in these studies does not allow any causality inference linking HD as a process to WM damage.…”