Dialysis-related hypotension as a cause of progressive frontal lobe atrophy in chronic hemodialysis patients: a 3-year prospective study.
OBJECTIVE
Brain atrophy is known to develop more rapidly in hemodialysis (HD) patients than other individuals. The present study was designed to examine the role of HD-related hypotension in brain atrophy in patients on chronic HD.


METHODS
By using magnetic resonance imaging, whole brain atrophy was assessed by the ventricular-brain ratio (VBR; ventricular area/whole brain area). Frontal brain atrophy was assessed by the frontal atrophy index (FAI; frontal brain area/intracranial frontal space). The number of lacunae was also counted. We studied 32 HD patients without symptomatic neurological abnormalities or diabetes mellitus: male/female ratio 19/13; mean age +/- SD 53 +/- 10 (range 28-77) years; mean HD duration +/- SD 11 +/- 6 (range 1-22) years. Magnetic resonance imagings were taken in 1995 and 1998. All dialysis-related hypotension episodes during the same period were identified from the medical records and counted.


RESULTS
The VBR ranged from 8.8 to 18.7% in 1995 (12.8 +/- 2.2%) and was not different in 1998 (13.1 +/- 2.7%). However, the VBR increased by more than 5% in 14 patients, and their HD duration of 13 +/- 6 years was significantly longer than that of 18 patients with stable VBR (p < 0.05). The FAI in 1995 was 62.2 +/- 4.2% (range 55.8-71.3%) and decreased significantly to 59.7 +/- 4.7% (range 50.2-70.9%) in 1998 (p < 0.05). The change in FAI correlated significantly with both the total number of dialysis-related hypotension episodes (r = 0.45, p < 0.05) and the increase in number of lacunae (r = 0.42, p < 0.05).


CONCLUSIONS
Our results suggest that dialysis-related hypotension plays a role in progressive frontal lobe atrophy in HD patients.
Mizumasa
Tohru
T
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Hirakata
Hideki
H
Yoshimitsu
Takahiro
T
Hirakata
Eriko
E
Kubo
Michiaki
M
Kashiwagi
Minoru
M
Tanaka
Hiroshi
H
Kanai
Hidetoshi
H
Fujimi
Satoru
S
Iida
Mitsuo
M
D000328:Adult; D000368:Aged; D001284:Atrophy / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005625:Frontal Lobe / Q000473:pathology*; D006801:Humans; D007022:Hypotension / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*