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Rajmohan N, Thiruvathtra J, Omkarappa S, Srinivasan SP, Eldo N, Rajgopal R. Perioperative optic nerve sheath diameter variations in patients with end-stage renal failure undergoing robotic-assisted kidney transplant: a prospective observational study. CLINICAL TRANSPLANTATION AND RESEARCH 2024; 38:106-115. [PMID: 38940687 PMCID: PMC11228382 DOI: 10.4285/ctr.24.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024]
Abstract
Background Patients with chronic kidney disease (CKD) who undergo hemodialysis are predisposed to interstitial cerebral edema. Robotic-assisted laparoscopic surgery can increase optic nerve sheath diameter (ONSD) and intracranial pressure. The impact of robotic-assisted kidney transplant (RAKT) on ONSD is complicated by the presence of CKD, the administration of furosemide and mannitol, and the manipulation of hemodynamics. We examined ONSD variations in patients undergoing RAKT over a 1-year period at our institution. Furthermore, we attempted to identify any perioperative hemodynamic factors influencing these changes. Methods This prospective study included 20 patients undergoing RAKT. ONSD, heart rate, central venous pressure, systolic blood pressure, diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured following intubation (T1), after assuming the steep Trendelenburg position (T2), 1 hour after docking (T3), upon reperfusion (T4), after transition to the supine position (T5), and 3 hours postextubation (T6). Repeated measures analysis of variance with post hoc Bonferroni correction was employed to compare variables at each time point. Pearson correlation analysis was utilized to assess relationships between variables. P-values ≤0.05 were considered to indicate statistical significance. Results ONSD (in mm) increased from T1 (3.60±0.44) to T3 (4.06±0.45, P=0.002) and T4 (3.99±0.62, P=0.046), before falling to its lowest value at T6 (3.42±0.64, P=0.002). Pearson correlation analysis revealed significant correlations (P<0.05) between changes in ONSD at T3 and both DBP (r=0.637) and MAP (r=0.522). Conclusions During RAKT with open ureteric anastomosis, ONSD initially increased, then decreased following reperfusion. DBP and MAP displayed positive correlations with ONSD changes at T3.
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Affiliation(s)
- Nisha Rajmohan
- Department of Anesthesia and Critical Care, Aster Medcity, Kochi, India
| | | | - Shilpa Omkarappa
- Department of Anesthesia and Critical Care, Aster Medcity, Kochi, India
| | | | - Nidhin Eldo
- Department of Anesthesia and Critical Care, Aster Medcity, Kochi, India
| | - Rajesh Rajgopal
- Department of Anesthesia and Critical Care, Aster Medcity, Kochi, India
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Chen HJ, Qiu J, Xu X, Guo Y, Fu L, Fu Q, Wu Y, Qi Y, Chen F. Abnormal white matter along fibers by automated fiber quantification in patients undergoing hemodialysis. Neurol Sci 2023; 44:4499-4509. [PMID: 37393206 DOI: 10.1007/s10072-023-06912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/13/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Abnormal white matter has been reported in patients with end-stage renal disease (ESRD). However, few studies have investigated the relationship between specific damage segments and cognition in ESRD. This study aimed to delineate white matter alterations in ESRD and its relationship with cognition. METHODS A total of 36 patients undergoing hemodialysis and 25 healthy controls underwent diffusion tensor imaging (DTI) and a series of neuropsychiatric tests. Automated fiber quantification was used to extract distinct DTI indices, and the relationship between the specific segment of the white matter and clinical properties was investigated. Furthermore, a support vector machine was applied to differentiate patients with ESRD from healthy controls. RESULTS Fractional anisotropy values decreased in multiple fiber bundles, including bilateral thalamic radiata, cingulum cingulate, inferior fronto-occipital fasciculus (IFOF), uncinate, Callosum_Forceps_Major/Callosum_Forceps_Minor (CFMaj/CFMin), and left uncinate from the tract level in patients with ESRD. Specific damaged segments were detected in 8 fiber bundles, including bilateral thalamic radiation, cingulum cingulate, IFOF, CFMin, and left corticospinal tract. Few alterations in these fiber bundles were correlated with cognition impairment and hemoglobin levels. The tract profiles of the left thalamic radiata and left cingulum cingulate could be used to differentiate hemodialysis patients from healthy controls, with an accuracy of 76.9% and 67.6%, respectively. CONCLUSIONS This study revealed white matter damage in hemodialysis patients. This damage occurred in specific segments of the tract, especially in the left thalamic radiata and left cingulum cingulate, which might become a new biomarker for patients with ESRD and cognition impairment.
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Affiliation(s)
- Hui Juan Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan, 570311, People's Republic of China
| | - Jie Qiu
- Department of Ultrasound, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan, 570311, People's Republic of China
| | - Xiaoling Xu
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan, 570311, People's Republic of China
| | - Yihao Guo
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan, 570311, People's Republic of China
| | - Lili Fu
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan, 570311, People's Republic of China
| | - Qingqing Fu
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan, 570311, People's Republic of China
| | - Yanglei Wu
- MR Collaboration, Siemens Healthineers Ltd, Beijing, China
| | - Yonghui Qi
- Blood Purification Center, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan, 570311, People's Republic of China.
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan, 570311, People's Republic of China.
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Li Y, Song J, Huq AM, Timilsina S, Gershwin ME. Posterior reversible encephalopathy syndrome and autoimmunity. Autoimmun Rev 2023; 22:103239. [PMID: 36464226 DOI: 10.1016/j.autrev.2022.103239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome characterized by acute or subacute onset of neurological symptoms (e.g., headache, seizure, confusion, vomiting, and diminished eyesight) and impaired endothelial barrier function of the cerebral circulation that leads to bilateral subcortical vasogenic edema, while exhibiting a "reversible" feature in most cases. Clinically, various predisposing or precipitating conditions have been identified, such as hypertension, autoimmune diseases, renal dysfunction/failure, preeclampsia/eclampsia, post-transplantation conditions, and certain therapeutic agents. Among several putative mechanisms, the immune activation hypothesis prevails, as up to 50% of patients with PRES harbor abnormalities related to autoimmunity, such as concurrent systemic lupus erythematosus. In this Review, we summarize the clinical and laboratory evidence that places PRES in the context of autoimmunity.
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Affiliation(s)
- Yang Li
- Department of Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, PR China
| | - Junmin Song
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, PR China.
| | - Ahm M Huq
- Department of Pediatrics, Central Michigan University, Detroit, MI 48201, USA
| | - Suraj Timilsina
- Division of Rheumatology/Allergy and Clinical Immunology, School of Medicine, University of California, Davis, CA 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology/Allergy and Clinical Immunology, School of Medicine, University of California, Davis, CA 95616, USA
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Positive coping style reduction in elderly end-stage renal disease patients: mediating role of white matter mean diffusivity. Neuroradiology 2022; 64:817-824. [DOI: 10.1007/s00234-022-02904-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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Zhang D, Chen Y, Wu H, Lin L, Xie Q, Chen C, Jing L, Wu J. Associations of the Disrupted Functional Brain Network and Cognitive Function in End-Stage Renal Disease Patients on Maintenance Hemodialysis: A Graph Theory-Based Study of Resting-State Functional Magnetic Resonance Imaging. Front Hum Neurosci 2021; 15:716719. [PMID: 34966264 PMCID: PMC8710547 DOI: 10.3389/fnhum.2021.716719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Cognitive impairment (CI) is a common neurological complication in patients with end-stage renal disease undergoing maintenance hemodialysis (MHD). Brain network analysis based on graph theory is a promising tool for studying CI. Therefore, the purpose of this study was to analyze the changes of functional brain networks in patients on MHD with and without CI by using graph theory and further explore the underlying neuropathological mechanism of CI in these patients. Methods: A total of 39 patients on MHD (19 cases with CI and 20 without) and 25 healthy controls (HCs) matched for age, sex, and years of education were enrolled in the study. Resting-state functional magnetic resonance imaging (rs-fMRI) and T1-weighted high-resolution anatomical data were obtained, and functional brain networks for each subject were constructed. The brain network parameters at the global and regional levels were calculated, and a one-way analysis of covariance was used to compare the differences across the three groups. The associations between the changed graph-theory parameters and cognitive function scores in patients on MHD were evaluated using Spearman correlation analysis. Results: Compared with HCs, the global parameters [sigma, gamma, and local efficiency (Eloc)] in both patient groups decreased significantly (p < 0.05, Bonferroni corrected). The clustering coefficient (Cp) in patients with CI was significantly lower than that in the other two groups (p < 0.05, Bonferroni corrected). The regional parameters were significantly lower in the right superior frontal gyrus, dorsolateral (SFGdor) and gyrus rectus (REC) of patients with CI than those of patients without CI; however the nodal local efficiency in the left amygdala was significantly increased (all p < 0.05, Bonferroni corrected). The global Cp and regional parameters in the three brain regions (right SFGdor, REC, and left amygdala) were significantly correlated with the cognitive function scores (all FDR q < 0.05). Conclusion: This study confirmed that the topology of the functional brain network was disrupted in patients on MHD with and without CI and the disruption of brain network was more severe in patients with CI. The abnormal brain network parameters are closely related to cognitive function in patients on MHD.
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Affiliation(s)
- Die Zhang
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.,Department of Radiology, Shenzhen Third People's Hospital, Shenzhen, China
| | - Yingying Chen
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.,Department of Radiology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Shenzhen Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shenzhen, China
| | - Hua Wu
- Department of Nephrology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Lin Lin
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Qing Xie
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Chen Chen
- Department of Nephrology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Li Jing
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Jiang Y, Gao Q, Liu Y, Gao B, Che Y, Lin L, Jiang J, Chang P, Song Q, Wang W, Wang N, Miao Y. Reduced White Matter Integrity in Patients With End-Stage and Non-end-Stage Chronic Kidney Disease: A Tract-Based Spatial Statistics Study. Front Hum Neurosci 2021; 15:774236. [PMID: 34955791 PMCID: PMC8709581 DOI: 10.3389/fnhum.2021.774236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Reduced white matter (WM) integrity has been implicated in chronic kidney disease (CKD), especially in end-stage renal disease (ESRD). However, whether the differences in WM abnormalities exist in ESRD and non-end-stage CKD (NES-CKD) remains unclear. Hence, this study aimed to investigate the WM microstructural changes between the two stages using diffusion tensor imaging (DTI) and explore the related influencing factors. Methods: Diffusion tensor imaging’ images were prospectively acquired from 18 patients with ESRD, 22 patients with NES-CKD, and 19 healthy controls (HCs). Tract-based spatial statistics (TBSS) was performed to assess the voxel-wise differences in WM abnormalities among the three groups. The relationships between DTI parameters and biochemical data were also analyzed. Results: Compared with NES-CKDs, FA value was significantly decreased, and AD value increased in ESRDs mainly in brain regions of bilateral anterior thalamic radiation (ATR), the genu and body of corpus callosum (CC), bilateral anterior corona radiata, superior corona radiata, and superior longitudinal fasciculus. Besides, extensive and symmetrical deep WM damages were observed in patients with ESRD, accompanied by increased MD and RD values. Multiple regression analysis revealed that uric acid and serum phosphorus level can be used as independent predictors of WM microstructural abnormalities in clusters with statistical differences in DTI parameters between ESRD and NES-CKD groups. Conclusion: In the progression of CKD, patients with ESRD have more severe WM microstructural abnormalities than NES-CKDs, and this progressive deterioration may be related to uric acid and phosphate levels.
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Affiliation(s)
- Yuhan Jiang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qiuyi Gao
- Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yangyingqiu Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bingbing Gao
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yiwei Che
- Department of Radiology, The Third People's Hospital of Dalian, Dalian, China
| | | | - Jian Jiang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Peipei Chang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qingwei Song
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Weiwei Wang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Nan Wang
- Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanwei Miao
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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7
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Jiang Y, Liu Y, Gao B, Che Y, Lin L, Jiang J, Chang P, Song Q, Wang N, Wang W, Miao Y. Segmental Abnormalities of White Matter Microstructure in End-Stage Renal Disease Patients: An Automated Fiber Quantification Tractography Study. Front Neurosci 2021; 15:765677. [PMID: 34938154 PMCID: PMC8685541 DOI: 10.3389/fnins.2021.765677] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: End-stage renal disease (ESRD) results in extensive white matter abnormalities, but the specific damage segment cannot be identified. This study aimed to determine the segmental abnormalities of white matter microstructure in ESRD and its relationship with cognitive and renal function indicators. Methods: Eighteen ESRD patients and 19 healthy controls (HCs) were prospectively recruited. All participants underwent DTI and clinical assessments. Automatic fiber quantification (AFQ) was applied to generate bundle profiles along 16 main white matter tracts. We compared the DTI parameters between groups. Besides, we used partial correlation and multiple linear regression analyses to explore the associations between white matter integrity and cognitive performance as well as renal function indicators. Results: In the global tract level, compared to HCs, ESRD patients had greater MD, AD, and RD values and lower FA value in several fibers (P < 0.05, FDR correction). In the point-wise level, extensive damage existed in specific locations of different fiber tracts, particularly in the left hemisphere (P < 0.05, FDR correction). Among these tracts, the mean AD values of the left cingulum cingulate correlated negatively with MoCA score. Urea and UA level were independent predictors of the AD value of superior component of the left corticospinal. Besides, urea level was the independent predictors of mean MD value of left anterior thalamic radiation (ATR). Conclusion: White matter fiber tract damage in ESRD patients may be characterized by abnormalities in its specific location, especially in the left hemisphere. Aberrational specific located fibers were related to cognitive impairment and renal dysfunction.
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Affiliation(s)
- Yuhan Jiang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yangyingqiu Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bingbing Gao
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yiwei Che
- Department of Radiology, The Third People's Hospital of Dalian, Dalian, China
| | | | - Jian Jiang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Peipei Chang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qingwei Song
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Nan Wang
- Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Weiwei Wang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanwei Miao
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Michna M, Kovarova L, Valerianova A, Malikova H, Weichet J, Malik J. Review of the structural and functional brain changes associated with chronic kidney disease. Physiol Res 2020; 69:1013-1028. [PMID: 33129242 PMCID: PMC8549872 DOI: 10.33549/physiolres.934420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) leads to profound metabolic and hemodynamic changes, which damage other organs, such as heart and brain. The brain abnormalities and cognitive deficit progress with the severity of the CKD and are mostly expressed among hemodialysis patients. They have great socio-economic impact. In this review, we present the current knowledge of involved mechanisms.
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Affiliation(s)
- M Michna
- Department of Radiology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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Wei K, Tran TT, Chang PW, Malekie A, Chu K, Alhilali L, Borzage MT, Mena E, Harrington MG, King KS. MRI Automated T1 Signal Intensity Detection of Diffuse Brain Manganese Accumulation in Cirrhosis. J Neuroimaging 2020; 31:186-191. [PMID: 33146918 DOI: 10.1111/jon.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Cirrhosis is associated with diffuse brain manganese deposition, which results in increased signal intensity (SI) in the brain on T1-weighted images, most often visualized in the globus pallidus. The purpose of this study was to determine if automated image intensity measurements can detect SI differences in the basal ganglia and other regions reported to have manganese deposition in patients with cirrhosis compared with controls. METHODS T1 FSPGR images were acquired on 28 patients with cirrhosis and 28 age-sex-matched controls. FreeSurfer T1 SI values were obtained for the globus pallidus, putamen, cerebral white matter, cerebral cortex, and brainstem. SI ratios were computed for globus pallidus normalized to white matter and brainstem. SI values and SI ratios were compared between groups using t-tests. RESULTS Among people with cirrhosis, T1 SI was significantly increased in the globus pallidus, putamen, cerebral white matter, cerebral cortex, and brainstem (P< .001), and the globus pallidus to brainstem ratio was significantly increased (P< .001). No significant difference was seen for globus pallidus to cerebral white matter T1 SI ratio (P = .38). CONCLUSIONS Automatic assessment of T1 SI allows for rapid, objective identification of widespread T1 shortening associated with manganese deposition in cirrhosis, consistent with the global deposition of neurotoxic manganese seen in pathology studies. This automated T1 assessment may have broader utility for other conditions beyond cirrhosis impacting T1 SI.
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Affiliation(s)
- Ke Wei
- Imaging Center, Huntington Medical Research Institutes, Pasadena, CA
| | - Thao T Tran
- Imaging Center, Huntington Medical Research Institutes, Pasadena, CA
| | - Patrick W Chang
- Internal Medicine, Keck School of Medicine at USC, Los Angeles, CA
| | - Annie Malekie
- Imaging Center, Huntington Medical Research Institutes, Pasadena, CA
| | - Karen Chu
- Imaging Center, Huntington Medical Research Institutes, Pasadena, CA
| | - Lea Alhilali
- Neuroradiology, Barrow Neurological Institute, Phoenix, AZ
| | - Matthew T Borzage
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Kevin S King
- Imaging Center, Huntington Medical Research Institutes, Pasadena, CA
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Richerson WT, Umfleet LG, Schmit BD, Wolfgram DF. Changes in Cerebral Volume and White Matter Integrity in Adults on Hemodialysis and Relationship to Cognitive Function. Nephron Clin Pract 2020; 145:35-43. [PMID: 33049742 DOI: 10.1159/000510614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/01/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients on hemodialysis (HD) have a significant burden of cognitive impairment. Characterizing the cerebral structural changes in HD patients compared to healthy controls and evaluating the relationship of cerebral structural integrity with cognitive performance in HD patients can help clarify the pathophysiology of the cognitive impairment in HD patients. METHODS In this cross-sectional study, in-center HD patients ≥50 years of age underwent brain structural and diffusion MRIs and cognitive assessment using the NIH Toolbox cognition battery. The cerebral imaging measures of the HD participants were compared to imaging from age-matched controls. Gray matter volume, white matter volume, and white matter integrity determined by diffusion tensor imaging parameters (including fractional anisotropy [FA]) were measured in both cohorts to determine differences in the cerebral structure between HD participants and healthy controls. The association between cognitive performance on the NIH Toolbox cognition battery and cerebral structural integrity was evaluated using multiple linear regression models. RESULTS We compared imaging measures form 23 HD participants and 15 age-matched controls. The HD participants had decreased gray matter volumes (526.8 vs. 589.5 cm3, p < 0.01) and worsened white matter integrity overall (FA values of 0.2864 vs. 0.3441, p < 0.01) within major white matter tracts compared to healthy controls. Decreases in white matter integrity in the left superior longitudinal fasciculus was associated with lower executive function scores (r2 = 0.24, p = 0.02) and inferior longitudinal fasciculus with lower memory scores (r = 0.25 and p = 0.03 for left and r2 = 0.21 and p = 0.03 for right). CONCLUSIONS HD patients have a pattern of decreased white matter integrity and gray matter atrophy compared to controls. Decreases in white matter integrity were associated with decreased cognitive performance in the HD population.
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Affiliation(s)
- Wesley T Richerson
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA,
| | - Laura G Umfleet
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dawn F Wolfgram
- Department of Medicine, Medical College of Wisconsin and Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
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Liu M, Wu Y, Wu X, Ma X, Yin Y, Fang H, Huang S, Su H, Jiang G. White Matter Microstructure Changes and Cognitive Impairment in the Progression of Chronic Kidney Disease. Front Neurosci 2020; 14:559117. [PMID: 33132823 PMCID: PMC7550453 DOI: 10.3389/fnins.2020.559117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/02/2020] [Indexed: 02/05/2023] Open
Abstract
Background Cognitive impairment is a well-defined complication of chronic kidney disease (CKD), but the neural mechanisms are largely unknown. Objectives The study aimed to assess white matter (WM) microstructure changes and their relationship with cognitive impairment development during CKD progression. Methods Diffusion tensor imaging (DTI) datasets were acquired from 38 patients with CKD (19 patients were at stage 3; 19 patients were at stage 4) and 22 healthy controls (HCs). Tract-based spatial statistics (TBSS) was implemented to assess the differences in WM integrity among the three groups. The associations between abnormal WM integrity and clinical indicators (digit symbol test scores, the type A number connection test scores, hemoglobin, serum urea, serum creatinine, serum calcium, and serum potassium levels) were also computed. Results Compared with patients with CKD at stage 3 and HCs, patients with CKD at stage 4 showed significantly lower fractional anisotropy (FA) and higher mean diffusivity (MD) in the corpus callosum (CC), anterior thalamic radiation, inferior fronto-occipital fasciculus, and inferior longitudinal fasciculus. Correlation analysis showed that the MD in the genu of CC was negatively associated with the digit symbol test scores (r = -0.61, p = 0.01), and the FA in the left anterior thalamic radiation was positively associated with the level of serum calcium (r = 0.58, p = 0.01). Conclusion Patients with non-end-stage CKD have multiple abnormalities in WM regions. DTI metrics change with the progression of CKD and are primarily associated with cognitive impairment. The reduced integrity of WM tracts may be related to a low level of blood calcium.
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Affiliation(s)
- Mengchen Liu
- The Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yunfan Wu
- The Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xixin Wu
- The Department of Nephrology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiaofen Ma
- The Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yi Yin
- The Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Huamei Fang
- The Department of Nephrology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Sihua Huang
- The Department of Nephrology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Huanhuan Su
- The Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guihua Jiang
- The Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
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12
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Gong X, Zou L, Wu H, Shan Y, Liu G, Zheng S, Wang L. Altered brain structural and cognitive impairment in end-stage renal disease patients with secondary hyperparathyroidism. Acta Radiol 2020; 61:796-803. [PMID: 31575287 DOI: 10.1177/0284185119878360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cognitive impairment has received attention as an important problem in patients with end-stage renal disease, although end-stage renal disease patients with secondary hyperparathyroidism have not been studied. PURPOSE To assess the pattern of brain volume changes in end-stage renal disease patients with secondary hyperparathyroidism by using voxel-based morphometry and correlating these measures with clinical markers and the Montreal Cognitive Assessment scores. MATERIAL AND METHODS Fifty end-stage renal disease patients with no anatomical abnormalities in conventional MRI (25 patients with secondary hyperparathyroidism, 14 men, mean age 42.20 ± 7.53 years; 25 patients without secondary hyperparathyroidism, 15 men, mean age 41.96 ± 6.17 years) were selected in this study. All patients underwent laboratory tests, neuropsychological tests, and MRI. Voxel-based morphometry analysis was performed to detect regional gray matter volume differences between the two groups. The relationships between abnormal gray matter volume and clinical markers and Montreal Cognitive Assessment scores were investigated. RESULTS Voxel-based morphometry revealed increased gray matter volume in end-stage renal disease patients with secondary hyperparathyroidism in the bilateral caudate and bilateral thalamus compared with non- secondary hyperparathyroidism end-stage renal disease patients (P < 0.05, FWE corrected). Regarding the laboratory and neuropsychological tests, we found significant correlations between volume in these brain regions and intact parathyroid hormone levels and negative correlations with the Montreal Cognitive Assessment scores. There were no significant associations between brain volume changes and other clinical data (disease duration, urea, creatinine, and uric acid levels). CONCLUSION Our results showed significantly increased gray matter volume in end-stage renal disease patients with secondary hyperparathyroidism, which was associated with intact parathyroid hormone levels and cognitive impairment. Serum intact parathyroid hormone levels may be a risk factor for cognitive impairment in end-stage renal disease patients with secondary hyperparathyroidism.
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Affiliation(s)
- Xijun Gong
- Department of Radiology, the Second Hospital of Anhui Medical University, Hefei, Anhui, PR China
- Medical Image Research Center, Anhui Medical University, Hefei, Anhui, PR China
| | - Liwei Zou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, PR China
| | - Hanqiu Wu
- Department of Radiology, the Second Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Yanqi Shan
- Department of Radiology, the Second Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Guiling Liu
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Suisheng Zheng
- Ping An Healthcare Diagnostics Center, Hefei, Anhui, PR China
| | - Longsheng Wang
- Department of Radiology, the Second Hospital of Anhui Medical University, Hefei, Anhui, PR China
- Medical Image Research Center, Anhui Medical University, Hefei, Anhui, PR China
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13
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Chen HJ, Wang YF, Wen J, Xu Q, Lu GM, Zhang LJ. Functional-structural relationship in large-scale brain networks of patients with end stage renal disease after kidney transplantation: A longitudinal study. Hum Brain Mapp 2020; 41:328-341. [PMID: 31571368 PMCID: PMC7268055 DOI: 10.1002/hbm.24804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022] Open
Abstract
It is unclear how the brain network changed after kidney transplantation (KT). We explored the patterns of large‐scale complex network after KT in end‐stage renal disease (ESRD) patients with resting‐state functional MRI (rs‐fMRI) and diffusion tensor imaging (DTI). Twenty‐one ESRD patients (14 men; mean age, 31.5 ± 9.9 years) scheduled for KT and 17 age‐ and gender‐matched healthy controls (HC) (8 men; mean age, 28.9 ± 7.2 years) were enrolled in this study. Each participant underwent rs‐fMRI and DTI scans in three time points (pre‐KT, 1 and 6 months after KT [for ESRD]). Graph theory analysis was used to characterize the topological properties by using functional and structural network connectivities intergroup correlation analysis was performed between functional/structural MR indexes and clinical markers. Compared with HC, pre‐KT ESRD patients showed an altered topological organization in both functional and structural networks. Compared with pre‐KT, increased node degree and node efficiency were observed for both functional and structural networks at 1 month after KT (all p < .05), which were further increased at 6 months after KT (p < .05). Both functional and structural networks did not recover completely at 6 months after KT (all p < .05). The patients showed an increased functional–structural connectivity coupling at 1 month after KT compared with HC (p = .041). A trend of progressive recovery of functional and structural connectivity networks was observed in ERSD patients after KT, which did not recover to the normal levels even in 6 months after KT. The study results underlie cognitive function recovery in ESRD patients following KT in the neuropathophysiological perspective.
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Affiliation(s)
- Hui J Chen
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.,Department of Radiology, Affiliated Hainan Hospital of Hainan Medical College, Hainan General Hospital, Haikou, Hainan, P.R. China
| | - Yun F Wang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jiqiu Wen
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Guang M Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Long J Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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14
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Oh SW, Park S, Cho NJ, Gil HW, Lee EY, Oh HG, Park ST. Evaluation of Cerebral Blood Flow Using Arterial Spin Labeling in Patients with Chronic Kidney Disease. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:912-919. [PMID: 36238175 PMCID: PMC9432203 DOI: 10.3348/jksr.2020.81.4.912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/08/2020] [Accepted: 05/16/2020] [Indexed: 11/15/2022]
Abstract
목적 대상과 방법 결과 결론
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Affiliation(s)
- Se Won Oh
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Samel Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Nam-jun Cho
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyo-Wook Gil
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Eun Young Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | | | - Sung-Tae Park
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
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15
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Shi Y, Tong C, Zhang M, Gao X. Altered functional connectivity density in the brains of hemodialysis end-stage renal disease patients: An in vivo resting-state functional MRI study. PLoS One 2019; 14:e0227123. [PMID: 31891646 PMCID: PMC6938298 DOI: 10.1371/journal.pone.0227123] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/12/2019] [Indexed: 01/25/2023] Open
Abstract
Background End-stage renal disease (ESRD) patients usually suffer from a high prevalence of central nervous system abnormalities, including cognitive impairment and emotional disorders, which severely influence their quality of life. There have been many neuroimaging research developments in ESRD patients with brain function abnormalities; however, the dysfunction of the salience network (SN) of them has received little attention. The purpose of this study was to investigate the changes of global functional connectivity density (gFCD) in brains of ESRD patients undergoing hemodialysis using resting-state functional magnetic resonance imaging (re-fMRI). Methods re-fMRI data were collected from 30 ESRD patients undergoing hemodialysis (14 men, 38.33±7.44 years old) and 30 matched healthy controls (13 men, 39.17±5.7 years old). Neuropsychological tests including the Montreal Cognitive Assessment (MoCA) and Beck Depression Inventory (BDI) were used to evaluate the neurocognitive and psychiatric conditions of the subjects. Blood biochemistry tests, including hemoglobin level, serum albumin level, blood urea level, serum phosphate, serum calcium, and parathyroid hormone level, and dialysis-related indicators, including blood pressure fluctuations in dialysis, single-pool Kt/V(spKt/V), and ultrafiltration volume of dialysis were obtained from the ESRD patients. A two-sample t-test was used to examine the group differences in gFCD between ESRD patients and healthy controls after controlling for age, gender and education. Results Compared with healthy controls, ESRD patients exhibited a significantly increased gFCD in the salience network, including the bilateral insula, and dorsal anterior cingulated cortex (dACC), and there was no significant correlation between gFCD and the structural mean grey matter volume in patients for every cluster in the brain regions showing significant different gFCD between the two groups. Furthermore, there were significant negative correlations between the degree of connectivity in the right insula and spKt/V. Conclusion Our findings revealed abnormal intrinsic dysconnectivity pattern of salience network-related regions in ESRD patients from the whole brain network perspective. The negative correlation between the right insula and spKt/V suggested that increased fractional removal of urea may reduce the pathological activity in the insula.
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Affiliation(s)
- Yan Shi
- Department of Nephrology, The Ninth People’s Hospital of Chongqing, Chongqing, China
| | - Chaoyang Tong
- Department of Medical Imaging, The Ninth People’s Hospital of Chongqing, Chongqing, China
| | - Minghao Zhang
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China
| | - Xiaoling Gao
- Department of Nephrology, The Ninth People’s Hospital of Chongqing, Chongqing, China
- * E-mail:
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16
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Schaier M, Wolf RC, Kubera K, Nagel S, Bartsch A, Zeier M, Bendszus M, Herweh C. Vasogenic Brain Edema During Maintenance Hemodialysis : Preliminary Results from Tract-based Spatial Statistics and Voxel-based Morphometry. Clin Neuroradiol 2019; 31:217-224. [PMID: 31848644 DOI: 10.1007/s00062-019-00865-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hemodialysis (HD), especially when first initiated, can cause neurological deterioration. Presumably this is due to transient cerebral edema, which has been observed using diffusion weighted magnetic resonance imaging (MRI) in experimental and human studies; however, this has not been investigated under maintenance hemodialysis (mHD). Moreover, there are no studies to date investigating regional effects of mHD on grey and white matter volumes. METHODS In this study eight patients with end stage renal disease (ESRD) were examined immediately before and after mHD sessions with multimodal MRI, including diffusion tensor imaging (DTI) and high-resolution structural imaging. Additionally, eight healthy, age-matched and sex-matched controls were examined for comparison. Data were analyzed using tract-based spatial statistics and voxel-based morphometry. RESULTS At baseline, ESRD patients had significantly reduced values of fractional anisotropy (FA) and axial diffusivity as well as bilaterally reduced grey matter volume in the insula, compared with controls. After the mHD session, FA further decreased while axial, radial, and mean diffusivity significantly increased ubiquitously throughout the white matter. Voxel-based morphometry revealed a corresponding significant increase in white matter volume in the central right hemisphere and splenium, as well as in cortical grey matter in the anterior medial frontal and cingulate cortex. None of the patients showed neurological deterioration. CONCLUSION In this study ESRD patients showed white matter changes indicative of chronic microstructural damage when compared with healthy controls, as previously reported. In addition, patients showed signs of a transient extracellular cerebral edema, which has not yet been observed in the absence of neurological symptoms.
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Affiliation(s)
- M Schaier
- Department of Medicine I (Nephrology), University Hospital Heidelberg, Heidelberg, Germany
| | - R C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - K Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - S Nagel
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - A Bartsch
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - M Zeier
- Department of Medicine I (Nephrology), University Hospital Heidelberg, Heidelberg, Germany
| | - M Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - C Herweh
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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17
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Venkatasubba Rao CP, Bershad EM, Calvillo E, Maldonado N, Damani R, Mandayam S, Suarez JI. Real-time Noninvasive Monitoring of Intracranial Fluid Shifts During Dialysis Using Volumetric Integral Phase-Shift Spectroscopy (VIPS): A Proof-of-Concept Study. Neurocrit Care 2019; 28:117-126. [PMID: 28547320 DOI: 10.1007/s12028-017-0409-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cerebral edema, which is associated with increased intracranial fluid, is often a complication of many acute neurological conditions. There is currently no accepted method for real-time monitoring of intracranial fluid volume at the bedside. We evaluated a novel noninvasive technique called "Volumetric Integral Phase-shift Spectroscopy (VIPS)" for detecting intracranial fluid shifts during hemodialysis. METHODS Subjects receiving scheduled hemodialysis for end-stage renal disease and without a history of major neurological conditions were enrolled. VIPS monitoring was performed during hemodialysis. Serum osmolarity, electrolytes, and cognitive function with mini-mental state examination (MMSE) were assessed. RESULTS Twenty-one monitoring sessions from 14 subjects (4 women), mean group age 50 (SD 12.6), were analyzed. The serum osmolarity decreased by a mean of 6.4 mOsm/L (SD 6.6) from pre- to post-dialysis and correlated with an increase in the VIPS edema index (E-Dex) of 9.7% (SD 12.9) (Pearson's correlation r = 0.46, p = 0.037). Of the individual determinants of serum osmolarity, changes in serum sodium level correlated best with the VIPS edema index (Pearson's correlation, r = 0.46, p = 0.034). MMSE scores did not change from pre- to post-dialysis. CONCLUSIONS We detected an increase in the VIPS edema index during hemodialysis that correlated with decreased serum osmolarity, mainly reflected by changes in serum sodium suggesting shifts in intracranial fluids.
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Affiliation(s)
- Chethan P Venkatasubba Rao
- Department of Neurology, Section of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, One Baylor Plaza, MS, NB 122, Houston, TX, 77030, USA.
| | - Eric M Bershad
- Department of Neurology, Section of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, One Baylor Plaza, MS, NB 122, Houston, TX, 77030, USA
| | - Eusebia Calvillo
- Department of Neurology, Section of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, One Baylor Plaza, MS, NB 122, Houston, TX, 77030, USA
| | - Nelson Maldonado
- Department of Neurology, Section of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, One Baylor Plaza, MS, NB 122, Houston, TX, 77030, USA
| | - Rahul Damani
- Department of Neurology, Section of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, One Baylor Plaza, MS, NB 122, Houston, TX, 77030, USA
| | - Sreedhar Mandayam
- Department of Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Jose I Suarez
- Department of Neurology, Section of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, One Baylor Plaza, MS, NB 122, Houston, TX, 77030, USA
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18
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Chiu YL, Tsai HH, Lai YJ, Tseng HY, Wu YW, Peng YS, Chiu CM, Chuang YF. Cognitive impairment in patients with end-stage renal disease: Accelerated brain aging? J Formos Med Assoc 2019; 118:867-875. [DOI: 10.1016/j.jfma.2019.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/12/2019] [Accepted: 01/16/2019] [Indexed: 12/22/2022] Open
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19
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Chou MC, Ko CH, Hsieh TJ, Chang JM, Chung WS. A preliminary report of longitudinal white matter alterations in patients with end-stage renal disease: A three-year diffusion tensor imaging study. PLoS One 2019; 14:e0215942. [PMID: 31039171 PMCID: PMC6490894 DOI: 10.1371/journal.pone.0215942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 04/11/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE End-stage renal disease (ESRD) patients exhibit silent white-matter alterations after long-term hemodialysis, which may be due to ESRD itself or the hemodialysis. The purpose of this study was to investigate the longitudinal white-matter alterations in the ESRD patients under 3-year long-term hemodialysis using voxel-wise analysis of diffusion tensor imaging (DTI). MATERIALS AND METHODS 15 ESRD patients and 15 age-matched healthy controls participated in this study. Due to the development of abnormal brain lesions in some cases, 13 ESRD patients and 13 age-matched healthy controls were enrolled and underwent cognitive function assessment and DTI acquisition at two-time points separated by 3 years. Voxel-based analysis was performed to globally detect white-matter alterations between the two groups as well as between the two scans within the two groups. RESULTS In the ESRD patients, diffusivity indices were significantly increased and the fractional anisotropy was significantly decreased in both scans, as compared with healthy controls. Longitudinal comparisons showed significant white-matter alterations in healthy controls in three years, but little or no significant alterations were noted in the ESRD patients after additional 3-year hemodialysis. CONCLUSION Poorer white matter integrity and cognitive function are noted in ESRD patients and the toxic effect of ESRD may be the major factor of white matter alterations.
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Affiliation(s)
- Ming-Chung Chou
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Hung Ko
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsyh-Jyi Hsieh
- Department of Medical imaging, Chi Mei Medical Center, Tainan, Taiwan
- Department of Radiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
| | - Jer-Ming Chang
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Shiuan Chung
- Department of Medical Imaging, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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20
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Deteriorated functional and structural brain networks and normally appearing functional–structural coupling in diabetic kidney disease: a graph theory-based magnetic resonance imaging study. Eur Radiol 2019; 29:5577-5589. [DOI: 10.1007/s00330-019-06164-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/18/2019] [Accepted: 03/14/2019] [Indexed: 01/25/2023]
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21
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Cheng BC, Chen PC, Chen PC, Lu CH, Huang YC, Chou KH, Li SH, Lin AN, Lin WC. Decreased cerebral blood flow and improved cognitive function in patients with end-stage renal disease after peritoneal dialysis: An arterial spin-labelling study. Eur Radiol 2019; 29:1415-1424. [PMID: 30105409 PMCID: PMC6510858 DOI: 10.1007/s00330-018-5675-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/06/2018] [Accepted: 07/17/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the relationship between cognitive impairment and brain perfusion using arterial spin labelling (ASL) in end-stage renal disease (ESRD) patients undergoing PD. METHODS ESRD patients undergoing PD were recruited. Laboratory screening, neuropsychological tests and ASL magnetic resonance imaging (MRI) were conducted prior to and after 6 months of PD. Age- and sex-matched normal subjects without ESRD served as the control group. Comparisons of regional CBF between ESRD patients before or after undergoing PD and normal controls were performed. Correlations between biochemical, neuropsychological and CBF data were also conducted to evaluate the relationships. RESULTS ESRD patients showed poor performance in many of the neuropsychological tests; PD improved cognition in some domains. Pre-PD patients had higher mean CBF than post-PD patients and normal controls, but no significant difference was found between the normal controls and post-PD patients. Negative correlations were observed pre-PD (regional CBF in left hippocampus vs. perseverative responses, r = -0.662, p = 0.014), post-PD (mean CBF vs. haemoglobin level, r = -0.766, p = 0.002), and before and after PD (change in CBF in the left putamen vs. change in haematocrit percentage, r = -0.808, p = 0.001). CONCLUSION Before PD, ESRD patients had increased cerebral perfusion that was related to poorer executive function, especially in the left hippocampus. Post-PD patients performed better in some cognitive test domains than pre-PD patients. The degree of anaemia, i.e., haemoglobin level or haematocrit percentage, might predict cognitive impairment in PD patients. KEY POINTS • In this study, ESRD patients before PD had cerebral hyperperfusion that was related to poorer executive function. • Post-PD patients performed better in some cognitive test domains than pre-PD patients did. • The degree of anaemia might predict cognitive impairment in PD patients.
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Affiliation(s)
- Ben-Chung Cheng
- Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Pei-Chin Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Kun-Hsien Chou
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Shau-Hsuan Li
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan.
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MacEwen C, Watkinson P, Tarassenko L, Pugh C. Cerebral ischemia during hemodialysis-finding the signal in the noise. Semin Dial 2018; 31:199-203. [PMID: 29430730 DOI: 10.1111/sdi.12679] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Hemodialysis patients have multiple risk factors for small vessel cerebrovascular disease and cognitive dysfunction. Hemodialysis itself may cause clinically significant neurological injury through repetitive cerebral ischemia. However, supporting evidence to date consists of epidemiological associations, expert opinion, and small, single-centre studies of variable methodological quality. Isolating the impact of intra-dialytic hemodynamic instability from underlying renal and vascular disease on clinically relevant functional outcomes would require very large, controlled studies, given the heterogeneity and confounding comorbidities of the population, and the complex relationship between blood pressure and cerebral oxygen delivery. There has been an increase in complementary physiological studies looking directly at intra-dialytic cerebral oxygen balance, which have provided supporting evidence for the occurrence of cerebral ischemia, often independently of hemodynamics. Data suggesting a relationship between these measures of oxygen balance and functional outcomes is only hypothesis-generating at this stage. We advocate the testing of interventions that aim to reduce intra-dialytic cerebral hypoxia (rather than hypotension) in sufficiently powered studies, followed by correlation with validated, longitudinal assessment of clinically relevant neurological damage.
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Affiliation(s)
- Clare MacEwen
- Oxford Kidney Unit, Oxford University Hospitals NHS Trust, Oxford, UK.,Adult Intensive Care Unit, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Peter Watkinson
- Adult Intensive Care Unit, Oxford University Hospitals NHS Trust, Oxford, UK.,Kadoorie Centre for Critical Care Research and Education, Oxford University, Oxford, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, Oxford University, Oxford, UK
| | - Christopher Pugh
- Oxford Kidney Unit, Oxford University Hospitals NHS Trust, Oxford, UK.,Nuffield Department of Medicine, Oxford University, Oxford, UK
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23
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Tangvoraphonkchai K, Davenport A. Extracellular Water Excess and Increased Self-Reported Fatigue in Chronic Hemodialysis Patients. Ther Apher Dial 2018; 22:152-159. [DOI: 10.1111/1744-9987.12648] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/25/2017] [Accepted: 10/09/2017] [Indexed: 12/13/2022]
Affiliation(s)
| | - Andrew Davenport
- UCL Centre for Nephrology; Royal Free Hospital, University College London; London UK
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Yin Y, Li M, Li C, Ma X, Yan J, Wang T, Fu S, Hua K, Wu Y, Zhan W, Jiang G. Reduced White Matter Integrity With Cognitive Impairments in End Stage Renal Disease. Front Psychiatry 2018; 9:143. [PMID: 29725309 PMCID: PMC5917068 DOI: 10.3389/fpsyt.2018.00143] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 04/03/2018] [Indexed: 12/11/2022] Open
Abstract
Background: End-stage renal disease (ESRD) is a serious public health problem, which can often lead to multiorgan dysfunction, such as cerebrovascular disease and cognitive damage. It is essential to understand cognitive impairment in patients with ESRD to develop better ESRD treatment and prevent further cognitive impairment. Cognitive impairment is believed to be related to structural abnormalities in the brain. Purpose: To investigate white matter microstructural abnormalities in patients with ESRD using TBSS analysis of DTI and to explore the possible mechanisms underlying the impaired cognitive function. Materials and Methods: A TBSS analysis of DTI data was to investigate the microstructural changes in their WM over the whole brain. We chose the white matter tracts or regions with significantly reduced FA as the regions of interest (ROIs), Pearson's correlations were performed between clinical indicators (Mini-Mental State Examination (MMSE), digit span task scores, serum creatinine, blood urea nitrogen and hemodialysis duration) and the mean FA value of the ROIs in the ESRD patients. Results: Lower FA and higher MD, AD and RD values were observed in widespread and symmetrical WM in ESRD patients than healthy controls (HCs), Pearson correlation analysis revealed a significantly positive correlation between the Mini-Mental State Examination (MMSE) scores and FA values in the right corona radiata and left anterior thalamic radiation (ATR) and demonstrated a significantly negative correlation between FA values and the serum creatinine and blood urea nitrogen in the ATR (P < 0.01) in addition, digit span task scores positively correlate with the FA value in the left anterior rather than in the corona radiata. No cluster survived when we adopted the False Discovery Rate (FDR) correction to multiple comparisons. Conclusion: Our study indicate widespread impairment of the white matter in ESRD patients. Damage to the thalamic radiation and corona radiata may affect cognitive function in ESRD patients, the reduced integrity of ATR may tend to affect the working memory while the damage to the corona radiata may involve the executive function impaired in ESRD patients. The accumulation of serum creatinine and blood urea nitrogen may contribute to the WM impairment.
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Affiliation(s)
- Yi Yin
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Meng Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chao Li
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaofen Ma
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jianhao Yan
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tianyue Wang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shishun Fu
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Kelei Hua
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yunfan Wu
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wenfeng Zhan
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guihua Jiang
- Guangdong Second Provincial General Hospital, Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
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25
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Ding D, Li P, Ma XY, Dun WH, Yang SF, Ma SH, Liu HJ, Zhang M. The relationship between putamen-SMA functional connectivity and sensorimotor abnormality in ESRD patients. Brain Imaging Behav 2017; 12:1346-1354. [DOI: 10.1007/s11682-017-9808-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ryu CW, Coutu JP, Greka A, Rosas HD, Jahng GH, Rosen BR, Salat DH. Differential associations between systemic markers of disease and white matter tissue health in middle-aged and older adults. J Cereb Blood Flow Metab 2017; 37:3568-3579. [PMID: 27298238 PMCID: PMC5669337 DOI: 10.1177/0271678x16653613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Age-associated cerebrovascular disease impacts brain tissue integrity, but other factors, including normal variation in blood markers of systemic health, may also influence the structural integrity of the brain. This cross-sectional study included 139 individuals between 40 to 86 years old who were physically healthy and cognitively intact. Eleven markers (total-cholesterol, high-density lipoprotein, low-density lipoprotein, triglyceride, insulin, fasting glucose, glycated hemoglobin, creatinine, blood urea nitrogen, albumin, total protein) and five derived indicators (estimated glomerular filtration rate, creatinine clearance rate, insulin-resistance, average glucose, and cholesterol/high-density lipoprotein ratio) were obtained from blood sampling. Diffusion tensor imaging was used to evaluate white matter tissue health. Blood markers were clustered into five factors. The first factor (defined as insulin/high-density lipoprotein factor) was associated with markers of integrity in the deep white matter and projection fiber systems, while the third factor (defined as kidney function factor) was associated with different markers of integrity in the periventricular and watershed white matter regions. Differential segregated associations for insulin and high-density lipoprotein levels and serum markers of kidney function may provide information about distinct mechanisms of brain changes across the lifespan. These results emphasize the need to determine whether therapeutic modulation of systemic health and organ function may prevent decline in brain structural integrity.
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Affiliation(s)
- Chang-Woo Ryu
- 1 MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,2 Department of Radiology, School of Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jean-Philippe Coutu
- 1 MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,3 Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Anna Greka
- 4 Renal Division, Department of Medicine, Glom-NExT Center, Brigham and Women's Hospital, Boston MA, USA.,5 Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - H Diana Rosas
- 1 MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,6 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Geon-Ho Jahng
- 2 Department of Radiology, School of Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Bruce R Rosen
- 1 MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,7 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David H Salat
- 1 MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,7 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,8 Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA, USA
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27
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Drew DA, Koo BB, Bhadelia R, Weiner DE, Duncan S, la Garza MMD, Gupta A, Tighiouart H, Scott T, Sarnak MJ. White matter damage in maintenance hemodialysis patients: a diffusion tensor imaging study. BMC Nephrol 2017; 18:213. [PMID: 28676035 PMCID: PMC5497357 DOI: 10.1186/s12882-017-0628-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/21/2017] [Indexed: 11/22/2022] Open
Abstract
Background Patients treated with dialysis have high rates of brain infarcts, brain atrophy, and white matter disease. There are limited data regarding the presence of more subtle damage to brain white matter. Methods In the Cognition and Dialysis Study, we compared brain structure using diffusion tensor imaging in hemodialysis (HD) patients to individuals without known kidney disease, using tract based spatial statistics (TBSS) to compare Fractional Anisotropy (FA) and Mean Diffusivity (MD). Statistical comparison of each overlaid voxel was age controlled using a permutation based corrected p value of <0.05. Results Thirty-four HD patients and twenty six controls (52 vs 51 years for HD vs control) had adequate magnetic resonance imaging for analysis. The HD group had fewer women (38% vs 23%) and a higher prevalence of diabetes (29% vs 8%), heart failure (29% vs 0%) and clinical stroke (15% vs 0%). Hemodialysis patients had significantly lower FA across multiple white matter fiber tracts, with fronto-temporal connections, the genu of the corpus callosum and the fornix more significantly affected than posterior regions of the brain. Similarly, HD patients had significantly higher mean diffusivity in multiple anterior brain regions. Results remained similar when those with a prior history of stroke were excluded. Conclusions In HD patients, there is more white matter disease in the anterior than posterior parts of the brain compared to controls without kidney disease. This pattern of injury is most similar to that seen in aging, suggesting that developing chronic kidney disease and ultimately kidney failure may result in a phenotype consistent with accelerated aging.
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Affiliation(s)
- David A Drew
- Division of Nephrology, Department of Medicine, Tufts Medical Center, 800 Washington Street, Box 391, Boston, MA, 02111, USA.
| | - Bang-Bon Koo
- Department of Neurobiology and Anatomy, Boston University School of Medicine, Boston, MA, USA
| | - Rafeeque Bhadelia
- Department of Radiology, Beth-Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel E Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center, 800 Washington Street, Box 391, Boston, MA, 02111, USA
| | - Sarah Duncan
- Division of Nephrology, Department of Medicine, Tufts Medical Center, 800 Washington Street, Box 391, Boston, MA, 02111, USA
| | | | - Aditi Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hocine Tighiouart
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Tammy Scott
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, 800 Washington Street, Box 391, Boston, MA, 02111, USA
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Cognitive Impairment in Chronic Kidney Disease: Vascular Milieu and the Potential Therapeutic Role of Exercise. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2726369. [PMID: 28503567 PMCID: PMC5414492 DOI: 10.1155/2017/2726369] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 02/28/2017] [Indexed: 02/08/2023]
Abstract
Chronic kidney disease (CKD) is considered a model of accelerated aging. More specifically, CKD leads to reduced physical functioning and increased frailty, increased vascular dysfunction, vascular calcification and arterial stiffness, high levels of systemic inflammation, and oxidative stress, as well as increased cognitive impairment. Increasing evidence suggests that the cognitive impairment associated with CKD may be related to cerebral small vessel disease and overall impairment in white matter integrity. The triad of poor physical function, vascular dysfunction, and cognitive impairment places patients living with CKD at an increased risk for loss of independence, poor health-related quality of life, morbidity, and mortality. The purpose of this review is to discuss the available evidence of cerebrovascular-renal axis and its interconnection with early and accelerated cognitive impairment in patients with CKD and the plausible role of exercise as a therapeutic modality. Understanding the cerebrovascular-renal axis pathophysiological link and its interconnection with physical function is important for clinicians in order to minimize the risk of loss of independence and improve quality of life in patients with CKD.
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Shen Z, Ruan Q, Yu Z, Sun Z. Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review. Geriatr Gerontol Int 2017; 17:529-544. [PMID: 27240548 DOI: 10.1111/ggi.12758] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/12/2016] [Indexed: 11/28/2022]
Abstract
AIM The objective of this review was to assess chronic kidney disease-related frailty and cognitive impairment, as well as their probable causes, mechanisms and the interventions. METHODS Studies from 1990 to 2015 were reviewed to evaluate the relationship between chronic kidney disease and physical frailty and cognitive impairment. Of the 1694 studies from the initial search, longitudinal studies (n = 22) with the keywords "Cognitive and CKD" and longitudinal or cross-sectional studies (n = 5) with the keywords "Frailty and CKD" were included in final analysis. RESULTS By pooling current research, we show clear evidence for a relationship between chronic kidney disease and frailty and cognitive impairment in major studies. Vascular disease is likely an important mediator, particularly for cognitive impairment. However, non-vascular factors also play an important role. Many of the other mechanisms that contribute to impaired cognitive function and increased frailty in CKD remain to be elucidated. In limited studies, medication therapy did not obtain the ideal effect. There are limited data on treatment strategies, but addressing the vascular disease risk factors earlier in life might decrease the subsequent burden of frailty and cognitive impairment in this population. Multidimensional interventions, which address both microvascular health and other factors, may have substantial benefits for both the cognitive impairments and physical frailty in this vulnerable population. CONCLUSIONS Chronic kidney disease is a potential cause of frailty and cognitive impairment. Vascular and non-vascular factors are the possible causes. The mechanism of chronic kidney disease-induced physical frailty and cognitive impairment suggests that multidimensional interventions may be effective therapeutic strategies in the early stage of chronic kidney disease. Geriatr Gerontol Int 2017; 17: 529-544.
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Affiliation(s)
- Zhiyuan Shen
- Department of Urology, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, China
| | - Qingwei Ruan
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhuowei Yu
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhongquan Sun
- Department of Urology, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, China
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Zhuang L, He Y, Xia H, Liu Y, Sy SKB, Derendorf H. Gentamicin dosing strategy in patients with end-stage renal disease receiving haemodialysis: evaluation using a semi-mechanistic pharmacokinetic/pharmacodynamic model. J Antimicrob Chemother 2015; 71:1012-21. [PMID: 26702923 DOI: 10.1093/jac/dkv428] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/10/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Gentamicin is widely used in end-stage renal disease (ESRD) patients for the treatment of infections. The goal of this study was to find the most reasonable dosing regimen for gentamicin in ESRD patients receiving haemodialysis. METHODS The in vitro antimicrobial activity of gentamicin was evaluated by static and dynamic time-kill experiments against three bacterial strains of MSSA, MRSA and Pseudomonas aeruginosa. A semi-mechanistic pharmacokinetic/pharmacodynamic (PK/PD) model was established afterwards, allowing the characterization of the antibacterial effect of gentamicin in the human body. The model was utilized to assess dosing regimens of gentamicin in ESRD patients receiving haemodialysis, taking both efficacy and safety into account. RESULTS The PK/PD model was capable of describing the bacterial response to gentamicin exposure in all three strains. Simulation based on the PK/PD model showed that pre-dialysis and post-dialysis dosing would bring comparable benefit to the ESRD patient regardless of whether the PK/PD target (fCmax/MIC >8-fold) was achieved, while the post-dialysis dosing resulted in a significantly lower trough concentration. The result of simulated dose fractionation demonstrated that both fCmax/MIC and fAUC(0-24)/MIC are strong predictors of drug effectiveness, but the PK/PD model would provide a more precise prediction of antibacterial activity as well as valuable information on dose selection in ESRD patients receiving haemodialysis. CONCLUSIONS Our study supports the original FDA label with regard to the dosing regimen of gentamicin in ESRD patients, which offers adequate clinical benefit as well as an acceptable safety profile.
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Affiliation(s)
- Luning Zhuang
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA Division of Pharmacometrics, Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 10903, USA
| | - Yang He
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Huiming Xia
- Division of Clinical Pharmacology IV, Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 10903, USA
| | - Yajun Liu
- Division of Bioequivalence II, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 10903, USA
| | - Sherwin K B Sy
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA Post-Graduate Program in Biostatistics, Department of Statistics, Maringa State University, Maringa, PR 87020, Brazil
| | - Hartmut Derendorf
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
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Sy SKB, Zhuang L, Derendorf H. Pharmacokinetics and pharmacodynamics in antibiotic dose optimization. Expert Opin Drug Metab Toxicol 2015; 12:93-114. [DOI: 10.1517/17425255.2016.1123250] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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32
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Su YY, Liang X, Schoepf UJ, Varga-Szemes A, West HC, Qi R, Kong X, Chen HJ, Lu GM, Zhang LJ. APOE Polymorphism Affects Brain Default Mode Network in Healthy Young Adults: A STROBE Article. Medicine (Baltimore) 2015; 94:e1734. [PMID: 26717353 PMCID: PMC5291594 DOI: 10.1097/md.0000000000001734] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To investigate the effect of apolipoprotein E (APOE) gene polymorphism on the resting-state brain function, structure, and blood flow in healthy adults younger than 35 years, using multimodality magnetic resonance (MR) imaging.Seventy-six healthy adults (34 men, 23.7 ± 2.8 y; 31 APOE ε4/ε3 carriers, 31 ε3/ε3 carriers, and 14 ε2/ε3 carriers) were included. For resting-state functional MRI data, default mode network (DMN) and amplitude of low-frequency fluctuation maps were extracted and analyzed. Voxel-based morphometry, diffusion tensor imaging from structural imaging, and cerebral blood flow based on arterial spin labeling MR imaging were also analyzed. Correlation analysis was performed between the above mentioned brain parameters and neuropsychological tests.There were no differences in neuropsychological performances, amplitude of low-frequency fluctuation, gray/white matter volumes, fractional anisotropy, mean diffusivity, or whole brain cerebral blood flow among the 3 groups. As for DMN, the ε4/ε3 group showed increased functional connectivities (FCs) in the left medial prefrontal cortex and bilateral posterior cingulate cortices/precuneus compared with the ε3/ε3 group, and increased FCs in the left medial prefrontal cortex and right temporal lobe compared with the ε2/ε3 group (P < 0.05, Alphasim corrected). No differences of DMN FCs were found between the ε2/ε3 and ε3/ε3 groups. FCs in the right temporal lobe positively correlated with the performances of vocabulary learning, delayed recall, and graph recall in all participants (P < 0.05).APOE ε4 carriers exhibited significantly increased DMN FCs when compared with ε3 and ε2 carriers. The ε4 affects DMN FCs before brain structure and blood flow in cognitively intact young patients, suggesting DMN FC may serve as a potential biomarker for the detection of early manifestations of genetic effect.
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Affiliation(s)
- Yun Yan Su
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nangjing, Jiangsu Province, China (YYS, XL, RQ, XK, HJC, GML, LJZ); and Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, Charleston, South Carolina (UJS, AV-S, HCW)
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Zhang XD, Wen JQ, Xu Q, Qi R, Chen HJ, Kong X, Wei LD, Xu M, Zhang LJ, Lu GM. Altered long- and short-range functional connectivity in the patients with end-stage renal disease: a resting-state functional MRI study. Metab Brain Dis 2015; 30:1175-86. [PMID: 26016622 DOI: 10.1007/s11011-015-9683-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/11/2015] [Indexed: 01/10/2023]
Abstract
To investigate alterations of functional connectivity density (FCD) in patients with end-stage renal disease (ESRD) by using resting-state functional magnetic resonance imaging (rs-fMRI). Medical research ethics committee approval from Jinling hospital and written informed consent from each subject were obtained. Forty six patients with ESRD, consisting of 21 patients minimal nephrotic encephalopathy (MNE) and 25 non-nephro-encephalopathy (non-NE), as well as 23 healthy controls underwent rs-fMRI. Neuropsychological tests were performed in all subjects, while laboratory tests were performed in ESRD patients. A voxel-wise whole brain functional connectivity analysis was used to generate long- and short-range FCD maps. The maps among MNE, non-NE, and healthy controls groups were compared by using one-way analysis of variance tests. A multiple regression analysis was performed to evaluate the correlations between FCD and the variables of neuropsychological or laboratory tests. Compared with healthy controls, non-NE showed decreased long-range FCD mainly in parietal lobe. Moreover, MNE showed further decreased long-range FCD in bilateral middle prefrontal cortex (MPFC), anterior cingulate cortex (ACC) and right superior frontal gyrus. Meanwhile, non-NE showed decreased short-range FCD mainly in frontal cortex, and further reduction in bilateral ACC and right superior parietal gyrus in MNE. In addition, patients with ESRD mainly exhibited increased long-range FCD in left temporal lobe and caudate; and increased short-range FCD in bilateral orbitofrontal cortex and temporal gyri (P < 0.05, AlphaSim corrected). The number connection test type A score, serum creatinine, urea, and dialysis duration showed negative correlation with FCD in some brain regions, while the digital symbol test scores positively correlated with short-range FCD in left inferior parietal lobule (all P < 0.05, AlphaSim corrected). The prominent long- and short-range FCD reduction was found mainly in default mode network (DMN) and bilateral frontal and parietal lobes, while the progressively decreased long- and short-range FCD in ACC/MPFC and the long-range FCD in left superior frontal gyrus from non-NE to MNE was associated with cognition dysfunction in ESRD patients.
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Affiliation(s)
- Xiao-Dong Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, Jiangsu Province, 210002, China
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Zhang LJ, Wen J, Liang X, Qi R, Schoepf UJ, Wichmann JL, Milliken CM, Chen HJ, Kong X, Lu GM. Brain Default Mode Network Changes after Renal Transplantation: A Diffusion-Tensor Imaging and Resting-State Functional MR Imaging Study. Radiology 2015. [PMID: 26200603 DOI: 10.1148/radiol.2015150004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate structural and functional alterations of the default mode network (DMN) in the brain after renal transplantation in patients with end-stage renal disease by using diffusion-tensor imaging and resting-state functional MR imaging. MATERIALS AND METHODS This prospective study was approved by the local medical research ethics committee, and written informed consent was obtained. Twenty-one patients with end-stage renal disease (15 men, six women; mean age ± standard deviation, 32 years ± 9.5) who were scheduled to undergo renal transplantation and 21 healthy control subjects (15 men, six women; mean age, 31 years ± 6.5) were included. Diffusion-tensor imaging and resting-state functional MR imaging were performed in all subjects. Patients were imaged both before and 1 month after renal transplantation. Structural (mean diffusivity, fractional anisotropy, path length, and number of tracts derived from diffusion-tensor imaging tractography) and functional (temporal correlation coefficient derived from resting-state functional MR imaging) connectivity of the DMN were quantitatively compared with two-sample t tests or paired t tests. Intergroup correlation analysis was performed to compare structural or functional indexes and results of neuropsychological or blood biochemistry tests. RESULTS Mean diffusivity was decreased in the fiber bundles connecting the posterior cingulate cortex and the precuneus to the bilateral inferior parietal lobules in patients after renal transplantation compared with that in patients before transplantation (P < .05). Temporal correlation coefficients for patients after renal transplantation nearly reached the levels of those for control subjects (all, P > .05). The change in mean diffusivity of the fiber bundles connecting the posterior cingulate cortex and the precuneus to the right inferior parietal lobule positively correlated with the change in hematocrit levels (r = 0.522, P = .015), the change in temporal correlation coefficients between the posterior cingulate cortex or precuneus and left or right inferior parietal lobules correlated with changes in number connection test type A scores (r = -0.549, P = .010) and digit symbol test scores (r = 0.533, P = .013). CONCLUSION Functional connectivity changes in the DMN, which were associated with improved hematocrit levels and cognitive function, may recover earlier than structural connectivity changes do 1 month after renal transplantation.
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Affiliation(s)
- Long Jiang Zhang
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Jiqiu Wen
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Xue Liang
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Rongfeng Qi
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - U Joseph Schoepf
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Julian L Wichmann
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Cole M Milliken
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Hui Juan Chen
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Xiang Kong
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Guang Ming Lu
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
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Multimodality MRI Findings in Patients with End-Stage Renal Disease. BIOMED RESEARCH INTERNATIONAL 2015; 2015:697402. [PMID: 26064943 PMCID: PMC4434172 DOI: 10.1155/2015/697402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/15/2015] [Indexed: 01/17/2023]
Abstract
Patients with end-stage renal disease (ESRD) suffer from a number of complex neurological complications including vascular damage and cognitive dysfunction. It is of great significance to detect the neurological complications and improve the prognosis of ESRD patients. Many new noninvasive MRI techniques have been steadily used for the diagnosis of occult central nervous system complications in ESRD patients. This gives an opportunity to understand the pathophysiological mechanisms of these neurological disorders. This paper is a review that presents the MRI findings of occult brain damage in ESRD patients, outlines the applications of advanced MRI techniques, and introduces a brief perspective in this study field.
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Reetz K, Abbas Z, Costa AS, Gras V, Tiffin-Richards F, Mirzazade S, Holschbach B, Frank RD, Vassiliadou A, Krüger T, Eitner F, Gross T, Schulz JB, Floege J, Shah NJ. Increased cerebral water content in hemodialysis patients. PLoS One 2015; 10:e0122188. [PMID: 25826269 PMCID: PMC4380497 DOI: 10.1371/journal.pone.0122188] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 02/10/2015] [Indexed: 12/27/2022] Open
Abstract
Little information is available on the impact of hemodialysis on cerebral water homeostasis and its distribution in chronic kidney disease. We used a neuropsychological test battery, structural magnetic resonance imaging (MRI) and a novel technique for quantitative measurement of localized water content using 3T MRI to investigate ten hemodialysis patients (HD) on a dialysis-free day and after hemodialysis (2.4±2.2 hours), and a matched healthy control group with the same time interval. Neuropsychological testing revealed mainly attentional and executive cognitive dysfunction in HD. Voxel-based-morphometry showed only marginal alterations in the right inferior medial temporal lobe white matter in HD compared to controls. Marked increases in global brain water content were found in the white matter, specifically in parietal areas, in HD patients compared to controls. Although the global water content in the gray matter did not differ between the two groups, regional increases of brain water content in particular in parieto-temporal gray matter areas were observed in HD patients. No relevant brain hydration changes were revealed before and after hemodialysis. Whereas longer duration of dialysis vintage was associated with increased water content in parieto-temporal-occipital regions, lower intradialytic weight changes were negatively correlated with brain water content in these areas in HD patients. Worse cognitive performance on an attention task correlated with increased hydration in frontal white matter. In conclusion, long-term HD is associated with altered brain tissue water homeostasis mainly in parietal white matter regions, whereas the attentional domain in the cognitive dysfunction profile in HD could be linked to increased frontal white matter water content.
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Affiliation(s)
- Kathrin Reetz
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Institute of Neuroscience and Medicine (INM-4), Research Centre Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
- * E-mail:
| | - Zaheer Abbas
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Institute of Neuroscience and Medicine (INM-4), Research Centre Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
| | - Ana Sofia Costa
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
| | - Vincent Gras
- Institute of Neuroscience and Medicine (INM-4), Research Centre Jülich GmbH, Jülich, Germany
| | - Frances Tiffin-Richards
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
| | - Shahram Mirzazade
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Institute of Neuroscience and Medicine (INM-4), Research Centre Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
| | - Bernhard Holschbach
- KfH Kuratorium für Dialyse und Nierentransplantation e.V., Stolberg, Germany
| | - Rolf Dario Frank
- Department of Internal Medicine, St.-Antonius-Hospital Eschweiler, Eschweiler, Germany
| | | | - Thilo Krüger
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Frank Eitner
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Theresa Gross
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Jörg Bernhard Schulz
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Nadim Jon Shah
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Institute of Neuroscience and Medicine (INM-4), Research Centre Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
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