title: Anatomic brain disease in hemodialysis patients: a cross-sectional study.
abstract: BACKGROUND
  Although dialysis patients are at high risk of stroke and have a high burden of cognitive impairment, there are few reports of anatomic brain findings in the hemodialysis population. Using magnetic resonance imaging of the brain, we compared the prevalence of brain abnormalities in hemodialysis patients with that in a control population without known kidney disease.
  
  
  METHODS
  Cross-sectional cohort.
  
  
  METHODS
  45 maintenance hemodialysis patients and 67 controls without reported kidney disease, both without history of known stroke.
  
  
  METHODS
  The primary predictor was dialysis status. Covariates included demographics (age, race, and sex), vascular risk factors (diabetes and hypertension), and cardiovascular disease (coronary artery disease and congestive heart failure).
  
  
  RESULTS
  Magnetic resonance imaging of the brain features, including severity of white matter disease and cerebral atrophy (sulcal prominence and ventricular atrophy), hippocampal size, and small-/large-vessel infarcts.
  
  
  METHODS
  Semiquantitative scale (0-9 for white matter disease and cerebral atrophy, 0-3 for hippocampal size) and infarct prevalence.
  
  
  RESULTS
  Mean ages of hemodialysis patients and controls were 55 ± 17 (SD) and 53 ± 13 years, respectively. In comparison to controls, hemodialysis patients had more severe white matter disease (1.6 vs 0.7) and cerebral atrophy (sulcal prominence, 2.3 vs 0.6; ventricular enlargement, 2.3 vs 0.9; hippocampal size, 1.3 vs 1.0), with all P < 0.001. In multivariable analyses, hemodialysis status was associated independently with worse white matter disease and atrophy grades. Hemodialysis patients also had a higher prevalence of small- (17.8%) and large- (7.8%) vessel infarcts than controls (combined, 22% vs 0%; P < 0.001).
  
  
  CONCLUSIONS
  The dialysis cohort likely is healthier than the overall US hemodialysis population, partly limiting generalizability.
  
  
  CONCLUSIONS
  Hemodialysis patients have more white matter disease and cerebral atrophy compared with controls without known kidney disease. Hemodialysis patients also have a high prevalence of unrecognized infarcts.
authors.affiliation: Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA 02111, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Drew
authors.forename: Rafeeque
authors.initials: R
authors.lastname: Bhadelia
authors.forename: Hocine
authors.initials: H
authors.lastname: Tighiouart
authors.forename: Vera
authors.initials: V
authors.lastname: Novak
authors.forename: Tammy M
authors.initials: TM
authors.lastname: Scott
authors.forename: Kristina V
authors.initials: KV
authors.lastname: Lou
authors.forename: Kamran
authors.initials: K
authors.lastname: Shaffi
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D055815:Young Adult