title: Diffuse interstitial brain edema in patients with end-stage renal disease undergoing hemodialysis: a tract-based spatial statistics study.
abstract: To investigate white matter (WM) alterations and their correlation with cognition function in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) using diffusion tensor imaging (DTI) with tract-based spatial statistics (TBSS) approach. This prospective HIPAA-complaint study was approved by our institutional review board. Eighty HD ESRD patients and 80 sex- and age-matched healthy controls were included. Neuropsychological (NP) tests and laboratory tests, including serum creatinine and urea, were performed. DTI data were processed to obtain fractional anisotropy (FA) and mean diffusivity (MD) maps with TBSS. FA and MD difference between the 2 groups were compared. We also explored the associations of FA values in WM regions of lower FA with ages, NP tests, disease, and dialysis durations, serum creatinine and urea levels of ESRD patients. Compared with controls, HD ESRD patients had lower FA value in the corpus callosum, bilateral corona radiate, posterior thalamic radiation, left superior longitudinal fasciculus, and right cingulum (P<0.05, FWE corrected). Almost all WM regions had increased MD in HD ESRD patients compared with controls (P<0.05, FWE corrected). In some regions with lower FA, FA values showed moderate correlations with ages, NP tests, and serum urea levels. There was no correlation between FA values and HD durations, disease durations, and serum creatinine levels of ESRD patients (all P>0.05). Diffuse interstitial brain edema and moderate WM integrity disruption occurring in HD ESRD patients, which correlated with cognitive dysfunction, and serum urea levels might be a risk factor for these WM changes.
authors.affiliation: From the Department of Medical Imaging (K-X, Q-RF, L-S, C-HJ, L-GM, Z-LJ); National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (W-JQ); Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY (Z-JH); and Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China (J-GJ).
authors.forename: Xiang
authors.initials: X
authors.lastname: Kong
authors.forename: Ji-Qiu
authors.initials: JQ
authors.lastname: Wen
authors.forename: Rong-Feng
authors.initials: RF
authors.lastname: Qi
authors.forename: Song
authors.initials: S
authors.lastname: Luo
authors.forename: Jian-Hui
authors.initials: JH
authors.lastname: Zhong
authors.forename: Hui-Juan
authors.initials: HJ
authors.lastname: Chen
authors.forename: Gong-Jun
authors.initials: GJ
authors.lastname: Ji
authors.forename: Guang Ming
authors.initials: GM
authors.lastname: Lu
authors.forename: Long Jiang
authors.initials: LJ
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D001929:Brain Edema / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D015203:Reproducibility of Results; D055815:Young Adult