Wang Xiaoyan, Chen Xiaohui, Tang Yuting, Zhang Liuping, Wang Yue, Hou Zhenghua, Jang Wenhao, Yuan Yonggui
Department of Psychosomatics and Psychiatry, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu, China.
Department of Nursing, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu, China.
Front Neurosci. 2023 Jan 19;16:980658. doi: 10.3389/fnins.2022.980658. eCollection 2022.
Patients with end-stage renal disease are more likely to suffer cognitive impairment. Cognitive impairment may lead to long-term severe adverse consequences.
To explore the impact of different blood purification therapy on cerebral blood flow and cognitive functions in end-stage renal disease.
This prospective study evaluated patients with end-stage renal disease undergoing blood purification from January to March 2021. Matched healthy controls were also included. Participants performed neurocognitive measurements, including a mini-mental state examination, logical memory test-20-minutes delayed, verbal fluency test, digit span test, clock drawing test, and stroop color and word test C. In addition, we tested plasma amyloid-β protein levels, serum Fe and hemoglobin levels in blood samples. Cerebral blood flow was measured using pulsed pseudocontinuous arterial spin labeling. We analyzed and compared the correlation between cognitive function, biomarkers, and cerebral blood flow between patients and healthy subjects, as well as between patients with different treatments.
A total of 44 patients with end-stage renal disease (mean age, 57.39 years ± 8.63) and 46 healthy controls (mean age, 56.15 years ± 6.40) were recruited. Patients receive hemodialysis three times a week, and 27 of them have been replaced hemodialysis for hemodiafiltration twice a month. The cognitive function of patients was worse than healthy controls ( < 0.05). The patients showed higher plasma concentrations of amyloid-β40, amyloid-β42, Tau, and pTau181 than healthy controls ( < 0.05). The group receiving both hemodialysis and hemodiafiltration had higher cerebral blood flow signal values in the left caudate nucleus (chuster-level < 0.05, voxel-level < 0.001). They also exhibited better verbal fluency function than the hemodialysis-only group ( < 0.05).
Patients with the end-stage renal disease showed widespread cognitive declines. Cerebral blood flow generally decreased in the cerebral cortex and increased in subcortical regions. The hemodiafiltration may protect verbal function by increasing cerebral blood flow in the left caudate.
终末期肾病患者更易出现认知障碍。认知障碍可能导致长期严重不良后果。
探讨不同血液净化疗法对终末期肾病患者脑血流及认知功能的影响。
本前瞻性研究评估了2021年1月至3月接受血液净化的终末期肾病患者。同时纳入了匹配的健康对照。参与者进行了神经认知测量，包括简易精神状态检查、20分钟延迟逻辑记忆测试、语言流畅性测试、数字广度测试、画钟试验和Stroop颜色和文字测试C。此外，我们检测了血样中的血浆淀粉样蛋白-β水平、血清铁和血红蛋白水平。使用脉冲伪连续动脉自旋标记测量脑血流。我们分析并比较了患者与健康受试者之间以及不同治疗患者之间认知功能、生物标志物和脑血流的相关性。
共招募了44例终末期肾病患者（平均年龄57.39岁±8.63）和46例健康对照（平均年龄56.15岁±6.40）。患者每周接受3次血液透析，其中27例已将血液透析改为每月2次血液滤过透析。患者的认知功能比健康对照差（P<0.05）。患者的血浆淀粉样蛋白-β40、淀粉样蛋白-β42、Tau和pTau181浓度高于健康对照（P<0.05）。接受血液透析和血液滤过透析的组在左侧尾状核的脑血流信号值更高（簇水平P<0.05，体素水平P<0.001）。他们的语言流畅性功能也比单纯血液透析组更好（P<0.05）。
终末期肾病患者存在广泛的认知功能下降。大脑皮层的脑血流普遍减少，皮层下区域增加。血液滤过透析可能通过增加左侧尾状核的脑血流来保护语言功能。
