Cerebrovascular Function is Altered in Hemodialysis Patients. Kidney360 2023 Dec 01;4(12):1717-1725
Date
11/14/2023Pubmed ID
37962988Pubmed Central ID
PMC10758518DOI
10.34067/KID.0000000000000292Scopus ID
2-s2.0-85181111137 (requires institutional sign-in at Scopus site)Abstract
KEY POINTS: Hemodialysis patients have impaired cerebrovascular reactivity. Hemodialysis patients have cerebral structural deficits.
BACKGROUND: Hemodialysis patients have declines in cerebral blood flow (CBF) and cerebral oxygenation during hemodialysis that may lead to ischemic brain injury. Cerebrovascular reactivity (CVR) may indicate which individuals are more susceptible to intradialytic hypoperfusion and ischemia. We hypothesized that hemodialysis patients would have decreased CVR and increased CBF relative to controls and deficits in CVR would be related to brain structural deficits.
METHODS: We measured cortical thickness and white matter hyperintensity (WMH) volume from T1 and T2 fluid attenuation inversion recovery images, respectively; CVR from a breath hold blood oxygen level–dependent CVR functional magnetic resonance imaging (fMRI); and arterial transit time and CBF from arterial spin labeling. Cerebrovascular and structural deficits in gray matter and white matter (GM and WM) were tested by averaging across the tissue and with a pothole analysis. Finally, we correlated cortical thickness and WMH volume with GM and WM cerebrovascular variables to assess the relationship between brain structure and cerebrovascular health.
RESULTS: In ten hemodialysis patients, cortical thickness was found to be decreased (P = 0.002), WMH volume increased (P = 0.004), and WM CBF increased (P = 0.02) relative to ten controls. Pothole analysis indicated a higher number of increased GM and WM CBF voxels (P = 0.03, P = 0.02) and a higher number of decreased GM and WM CVR voxels (P = 0.02, P = 0.01).
CONCLUSIONS: This pilot study demonstrates that hemodialysis patients have decreased CVR and increased CBF relative to controls, along with reduced brain integrity. Further investigation is required to fully understand whether these cerebrovascular deficits may lead to structural changes.
Author List
Richerson WT, Meier TB, Cohen AD, Wang Y, Goodman MJ, Schmit BD, Wolfgram DFAuthors
Timothy B. Meier PhD Associate Professor in the Neurosurgery department at Medical College of WisconsinBrian Schmit PhD Professor in the Biomedical Engineering department at Marquette University
Yang Wang MD Professor in the Radiology department at Medical College of Wisconsin
Dawn Felicity Wolfgram MD Associate Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
BrainHumans
White Matter
