title: Cerebral blood flow changes in hemodialysis and peritoneal dialysis patients: an arterial-spin labeling MR imaging.
abstract: We used arterial-spin labeling (ASL) MR imaging, a non-invasive technique to evaluate cerebral blood flow (CBF) changes in patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) and hemodialysis (HD), and nondialysis ESRD patients compared with healthy cohort. Ninety seven ESRD patients including 32 PD patients (20 male, 12 female; mean age 33 ± 8 years), 33 HD patients (22 male, 11 female; mean age 33 ± 8 years) and 32 nondialysis patients (20 male, 12 female; mean age 35 ± 7 years) and 31 age- and gender-matched healthy controls (20 male, 11 female; mean age 32 ± 8 years) were included in this study. All subjects underwent ASL MR imaging, neuropsychologic tests, and ESRD patients underwent laboratory testing. CBF values were compared among PD, HD, nondialysis patients and control groups. Correlation analysis and multiple regression analysis were performed to investigate the association between CBF values and hemoglobin, neuropsychologic test results, serum creatinine, urea levels, disease duration, and dialysis duration. Elevated CBFs of whole brain region, gray matter, and white matter were found in all ESRD patient groups compared with healthy controls (all P < 0.001). However, compared with non-dialysis ESRD patients, both PD and HD patients had widespread regional CBF decline mainly in bilateral frontal and anterior cingulate cortices. There were no differences for CBF between PD and HD patient groups. Negative correlations were observed between mean CBFs of whole brain region, gray matter, and white matter and the hemoglobin level in all ESRD patients. Multiple linear regression showed elevated CBF of multiple brain areas correlated with some neuropsychological tests in ESRD patients (all P < 0.001, AlphaSim corrected), but the association was not present or shrank after adjusting hemoglobin level. This study found that mean CBF was predominantly increased in patients with ESRD, which correlated with their hemoglobin level and neurocognitive disorders. There were no differences of CBF change and cognitive function between PD and HD ESRD patients with long-term treatment. The degree of anemia may be a predominant risk factor for cognitive impairment in these ESRD patients.
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
authors.forename: Xiao Lu
authors.initials: XL
authors.lastname: Jiang
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jingling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
authors.forename: Ji Qiu
authors.initials: JQ
authors.lastname: Wen
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
authors.forename: Long Jiang
authors.initials: LJ
authors.lastname: Zhang
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China. gang.zheng@nuaa.edu.cn.|College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, 210016, China. gang.zheng@nuaa.edu.cn.
authors.forename: Gang
authors.initials: G
authors.lastname: Zheng
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jingling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Li
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jingling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.|College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, 210016, China.
authors.forename: Ya
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
authors.forename: Li Juan
authors.initials: LJ
authors.lastname: Zheng
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
authors.forename: Long
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
authors.forename: Hui Juan
authors.initials: HJ
authors.lastname: Chen
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Kong
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
authors.forename: Song
authors.initials: S
authors.lastname: Luo
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
authors.forename: Guang Ming
authors.initials: GM
authors.lastname: Lu
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China. jixueman@126.com.
authors.forename: Xue Man
authors.initials: XM
authors.lastname: Ji
authors.affiliation: Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China. 13814020968@163.com.
authors.forename: Zong Jun
authors.initials: ZJ
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D010530:Peritoneal Dialysis; D006435:Renal Dialysis; D013113:Spin Labels; D055815:Young Adult
chemical_list: D013113:Spin Labels
keywords: Arterial-spin labeling (ASL); Cerebral blood flow (CBF); End-stage renal disease (ESRD); Hemodialysis (HD); Peritoneal dialysis (PD)