Qi Yu, Song Lijun, Liu Xu, Xu Boyan, Yang Wenbo, Li Mingan, Li Min, Zhu Zhengyang, Liu Wenhu, Yang Zhenghan, Wang Zhenchang, Wang Hao
Department of Radiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Clin Kidney J. 2024 Sep 16;17(10):sfae286. doi: 10.1093/ckj/sfae286. eCollection 2024 Oct.
End-stage renal disease (ESRD) patients on maintenance haemodialysis (HD) often have damage to brain white matter (WM) and cognitive impairment. However, whether this damage is caused by maintenance HD or renal dysfunction is unclear. Herein we investigate the natural progression of WM damage in patients with ESRD and the effects of HD on WM using tract-based spatial statistics (TBSS) and fixel-based analysis (FBA).
Eighty-one ESRD patients, including 41 with no dialysis (ND) and 40 on HD, and 46 healthy controls (HCs) were enrolled in this study. The differences in WM among the three groups [ESRD patients with HD (ESRD-HD), ESRD patients without HD (ESRD-ND) and HCs] were analysed using TBSS and FBA. Pairwise comparison was then used to compare the differences in WM between two groups. The relationships between WM and neurocognitive assessments/clinical data were analysed in ESRD patients with and without HD.
The damage to WM in ESRD-ND and ESRD-HD appeared around the lateral ventricles in TBSS, while FBA reflected that the changes had extended to adjacent WM in the anterior hemisphere, with a larger region in ESRD-HD compared with ESRD-ND and the brainstem was also widely affected in ESRD-HD. The Montreal Cognitive Assessment (MoCA) scores were lower in the ESRD-HD group. RD in the body of the corpus callosum were negatively correlated with MoCA scores in both groups. Fiber density and cross-section (FDC) in the left thalamo-prefrontal projection (T_PREFL) and left and right cingulum (CGL and CGR) were positively correlated with MoCA scores in both groups. Creatinine (Cr) was positively correlated with FDC in some frontal projection fibres in the striatum and thalamus, CG and fronto-pontine tract and was positively correlated with FD mainly in premotor projection fibres in the striatum and thalamus in the ESRD-HD group. Cr was negatively correlated with mean and radial diffusivity in regions of the corona radiata in the ESRD-ND group.
FBA is more sensitive in detecting differences between ESRD patients and HCs. When ESRD patients receive maintenance HD, the degree of WM damage may not be aggravated, but the range of damaged WM may be expanded, especially in the anterior hemisphere and brainstem. Some of these changes in the anterior hemisphere may contribute to cognitive decline.
维持性血液透析（HD）的终末期肾病（ESRD）患者常存在脑白质（WM）损伤和认知障碍。然而，这种损伤是由维持性HD还是肾功能不全引起尚不清楚。在此，我们使用基于束的空间统计学（TBSS）和基于固定点的分析（FBA）来研究ESRD患者WM损伤的自然进展以及HD对WM的影响。
本研究纳入了81例ESRD患者，包括41例未透析（ND）患者和40例HD患者，以及46例健康对照（HCs）。使用TBSS和FBA分析三组[HD的ESRD患者（ESRD-HD）、未透析的ESRD患者（ESRD-ND）和HCs]之间WM的差异。然后使用成对比较来比较两组之间WM的差异。分析了HD和未HD的ESRD患者中WM与神经认知评估/临床数据之间的关系。
在TBSS中，ESRD-ND和ESRD-HD患者的WM损伤出现在侧脑室周围，而FBA显示这些变化已扩展到前脑相邻的WM，ESRD-HD组的区域比ESRD-ND组更大，并且ESRD-HD组的脑干也受到广泛影响。ESRD-HD组的蒙特利尔认知评估（MoCA）评分较低。两组胼胝体体部的径向扩散率（RD）与MoCA评分均呈负相关。两组左侧丘脑-前额叶投射（T_PREFL）以及左侧和右侧扣带（CGL和CGR）的纤维密度和横截面积（FDC）与MoCA评分均呈正相关。肌酐（Cr）与纹状体和丘脑的一些额叶投射纤维、扣带回和额桥束中的FDC呈正相关，在ESRD-HD组中主要与纹状体和丘脑的运动前投射纤维中的纤维密度（FD）呈正相关。在ESRD-ND组中，Cr与放射冠区域的平均扩散率和径向扩散率呈负相关。
FBA在检测ESRD患者与HCs之间的差异时更敏感。当ESRD患者接受维持性HD时，WM损伤程度可能不会加重，但受损WM的范围可能会扩大，尤其是在前脑和脑干。前脑的一些这些变化可能导致认知下降。
