Pi Hai-Chen, Xu Yu-Feng, Xu Rong, Yang Zhi-Kai, Qu Zhen, Chen Yu-Qing, Liu Gui-Ling, Dong Jie
Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, China.
Kidney Blood Press Res. 2016;41(6):986-996. doi: 10.1159/000452603. Epub 2016 Dec 19.
BACKGROUND/AIMS: Cognitive impairment and abnormal structural neuroimaging is common in chronic kidney disease patients. We aimed to explore its association with dialysis modality and the relationship between cognitive impairment and abnormal structural neuroimaging.
Sixty peritoneal dialysis patients and 30 hemodialysis and 30 non-dialyzed stage 3-5 chronic kidney disease patients without history of stroke were enrolled for the study. Participants were matched for age, gender, education, diabetes status, and dialysis duration (if appropriate). Cognitive functions were measured using a battery of recognized instruments. Brain features were examined with 3-dimensional magnetic resonance imaging.
Cognitive impairment was significantly more severe in dialysis patients than in non-dialyzed patients. The global and specific cognitive function were not significantly different between patients on peritoneal dialysis and hemodialysis. Hemodialysis patients had more severe white matter hyperintensity, sulcal and ventricular atrophy, and SVIs than other patients. In all groups, higher white matter grade, ventricular grade, and hippocampal atrophy were significantly associated with global cognitive impairment, with hazard ratios of 1.80 (1.22-2.64), 1.67 (1.09-2.57), and 2.49 (1.07-5.77), respectively. White matter grade was also significantly associated with delayed memory (hazard ratio 1.63; 1.12-2.39).
Dialysis modality showed no association with cognitive impairment, although hemodialysis patients had more severe neuroimaging abnormalities. For the whole group, white matter hyperintensity, and ventricular and hippocampal atrophy, were independently associated with global cognitive impairment in chronic kidney disease patients.
背景/目的：认知障碍和神经影像学结构异常在慢性肾脏病患者中很常见。我们旨在探讨其与透析方式的关联以及认知障碍与神经影像学结构异常之间的关系。
本研究纳入了60例腹膜透析患者、30例血液透析患者以及30例未透析的3-5期慢性肾脏病患者，这些患者均无卒中病史。根据年龄、性别、教育程度、糖尿病状态和透析时间（如适用）对参与者进行匹配。使用一系列公认的工具测量认知功能。通过三维磁共振成像检查脑特征。
透析患者的认知障碍明显比未透析患者更严重。腹膜透析患者和血液透析患者的整体及特定认知功能无显著差异。血液透析患者比其他患者有更严重的白质高信号、脑沟和脑室萎缩以及脑微出血。在所有组中，较高的白质分级、脑室分级和海马萎缩与整体认知障碍显著相关，风险比分别为1.80（1.22-2.64）、1.67（1.09-2.57）和2.49（1.07-5.77）。白质分级也与延迟记忆显著相关（风险比1.63；1.12-2.39）。
尽管血液透析患者的神经影像学异常更严重，但透析方式与认知障碍无关联。对于整个研究组，白质高信号、脑室和海马萎缩与慢性肾脏病患者的整体认知障碍独立相关。
