title: Brain atrophy in peritoneal dialysis and CKD stages 3-5: a cross-sectional and longitudinal study.
abstract: BACKGROUND
  Brain atrophy has been reported in patients with end-stage renal disease receiving hemodialysis, although its mechanism is unknown. However, little is known regarding brain atrophy in patients receiving peritoneal dialysis (PD). Therefore, we examined brain volume and its annual change over 2 years in PD patients compared with patients with non-dialysis-dependent chronic kidney disease (NDD-CKD).
  
  
  METHODS
  Cross-sectional and longitudinal cohort.
  
  
  METHODS
  62 PD patients and 69 patients with NDD-CKD with no history of cerebrovascular disease who underwent brain magnetic resonance imaging (MRI) were recruited in a cross-sectional study. Among them, 34 PD patients and 61 patients with NDD-CKD, who underwent a second brain MRI after 2 years, were recruited in a longitudinal study.
  
  
  METHODS
  PD therapy versus NDD-CKD.
  
  
  METHODS
  T1-weighted magnetic resonance images were analyzed. Total gray matter volume (GMV), total white matter volume (WMV), and cerebrospinal fluid space volume were segmented, and each volume was quantified using statistical parametric mapping software. Normalized GMV and WMV values were calculated by division of GMV and WMV by intracranial volume to adjust for variations in head size. We compared normalized GMV and normalized WMV between PD patients and patients with NDD-CKD in the cross-sectional study and the annual change in normalized GMV in the longitudinal study.
  
  
  RESULTS
  In the cross-sectional study, normalized GMV, which was correlated inversely with age, was lower in PD patients than in patients with NDD-CKD. However, normalized WMV, which was not correlated with age, was comparable between the groups. Annual change in normalized GMV was significantly higher in PD patients than in patients with NDD-CKD. These differences remained significant even after adjustment for potential confounding factors.
  
  
  CONCLUSIONS
  A short observation period and high dropout rate in the longitudinal study.
  
  
  CONCLUSIONS
  Decline in normalized GMV is faster in PD patients than in patients with NDD-CKD.
authors.affiliation: Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: tsuruya@intmed2.med.kyushu-u.ac.jp.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Tsuruya
authors.affiliation: Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Yoshida
authors.affiliation: Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kuroki
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Nagata
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kyushu Central Hospital, Fukuoka, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Mizumasa
authors.affiliation: Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Mitsuiki
authors.affiliation: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshiura
authors.affiliation: Division of Nephrology, Harasanshin Hospital, Fukuoka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirakawa
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kanai
authors.affiliation: Kidney Center, Munakata Medical Association Hospital, Munakata, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Hori
authors.affiliation: Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Hirakata
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
mesh_terms: D000368:Aged; D001284:Atrophy / Q000175:diagnosis / Q000453:epidemiology; D001921:Brain / Q000473:pathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000639:trends; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000628:therapy*
keywords: Chronic kidney disease (CKD); brain atrophy; brain volume; gray matter volume (GMV); magnetic resonance imaging (MRI); peritoneal dialysis (PD); white matter volume (WMV)