Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Am J Kidney Dis. 2015 Feb;65(2):312-21. doi: 10.1053/j.ajkd.2014.07.011. Epub 2014 Sep 11.
Brain atrophy has been reported in patients with end-stage renal disease receiving hemodialysis, although its mechanism is unknown. However, little is known regarding brain atrophy in patients receiving peritoneal dialysis (PD). Therefore, we examined brain volume and its annual change over 2 years in PD patients compared with patients with non-dialysis-dependent chronic kidney disease (NDD-CKD).
Cross-sectional and longitudinal cohort.
SETTING & PARTICIPANTS: 62 PD patients and 69 patients with NDD-CKD with no history of cerebrovascular disease who underwent brain magnetic resonance imaging (MRI) were recruited in a cross-sectional study. Among them, 34 PD patients and 61 patients with NDD-CKD, who underwent a second brain MRI after 2 years, were recruited in a longitudinal study.
PD therapy versus NDD-CKD.
OUTCOMES & MEASUREMENTS: T1-weighted magnetic resonance images were analyzed. Total gray matter volume (GMV), total white matter volume (WMV), and cerebrospinal fluid space volume were segmented, and each volume was quantified using statistical parametric mapping software. Normalized GMV and WMV values were calculated by division of GMV and WMV by intracranial volume to adjust for variations in head size. We compared normalized GMV and normalized WMV between PD patients and patients with NDD-CKD in the cross-sectional study and the annual change in normalized GMV in the longitudinal study.
In the cross-sectional study, normalized GMV, which was correlated inversely with age, was lower in PD patients than in patients with NDD-CKD. However, normalized WMV, which was not correlated with age, was comparable between the groups. Annual change in normalized GMV was significantly higher in PD patients than in patients with NDD-CKD. These differences remained significant even after adjustment for potential confounding factors.
A short observation period and high dropout rate in the longitudinal study.
Decline in normalized GMV is faster in PD patients than in patients with NDD-CKD.
尽管终末期肾病接受血液透析的患者存在脑萎缩，但脑萎缩的机制尚不清楚。然而，接受腹膜透析（PD）的患者的脑萎缩情况知之甚少。因此，我们比较了 PD 患者与非透析依赖性慢性肾脏病（NDD-CKD）患者的脑容量及其 2 年内的年度变化。
横断面和纵向队列研究。
在一项横断面研究中，招募了 62 名 PD 患者和 69 名无脑血管疾病史的 NDD-CKD 患者，他们接受了脑部磁共振成像（MRI）检查。其中，34 名 PD 患者和 61 名 NDD-CKD 患者在 2 年后接受了第二次脑部 MRI 检查，他们被招募入纵向研究。
PD 治疗与 NDD-CKD。
分析 T1 加权磁共振图像。通过统计参数映射软件对总灰质体积（GMV）、总白质体积（WMV）和脑脊液空间体积进行分割，并对每个体积进行量化。通过将 GMV 和 WMV 除以颅内体积来计算 GMV 和 WMV 的归一化值，以调整头部大小的变化。我们比较了横断面研究中 PD 患者与 NDD-CKD 患者之间的归一化 GMV 和归一化 WMV，以及纵向研究中归一化 GMV 的年度变化。
在横断面研究中，与年龄呈负相关的归一化 GMV 低于 NDD-CKD 患者，但与年龄不相关的归一化 WMV 在两组之间无差异。PD 患者的归一化 GMV 年变化率明显高于 NDD-CKD 患者。即使在调整了潜在混杂因素后，这些差异仍然显著。
纵向研究的观察期短，失访率高。
PD 患者的归一化 GMV 下降速度快于 NDD-CKD 患者。
