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Published on: October 2, 2020
Anatomic brain disease in hemodialysis patients: a cross-sectional study
David A Drew1, Rafeeque Bhadelia, Hocine Tighiouart
1Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA 02111, USA.
Insights
Patients on hemodialysis show significantly more brain abnormalities, including white matter disease and cerebral atrophy, compared to controls. This study highlights a high prevalence of unrecognized brain infarcts in hemodialysis patients.
Area of Science:
- Neurology
- Nephrology
- Radiology
Background:
- Dialysis patients face high risks of stroke and cognitive impairment.
- Anatomic brain findings in hemodialysis patients are underreported.
- This study investigates brain abnormalities in hemodialysis patients using MRI.
Purpose of the Study:
- To compare the prevalence of brain abnormalities in hemodialysis patients versus a control group.
- To identify specific MRI-detected brain changes associated with hemodialysis.
Main Methods:
- Cross-sectional cohort study comparing 45 hemodialysis patients with 67 controls.
- Brain MRI was used to assess white matter disease, cerebral atrophy, hippocampal size, and infarcts.
- Semiquantitative scales and prevalence rates were used for measurements.
Main Results:
- Hemodialysis patients exhibited significantly more severe white matter disease and cerebral atrophy (P < 0.001).
- Dialysis status independently predicted worse white matter disease and atrophy.
- A higher prevalence of small- and large-vessel infarcts was observed in hemodialysis patients (22% vs 0%, P < 0.001).
Conclusions:
- Hemodialysis patients demonstrate increased white matter disease and cerebral atrophy compared to controls.
- A substantial proportion of hemodialysis patients have unrecognized brain infarcts.
- Findings suggest significant subclinical cerebrovascular changes in the hemodialysis population.
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.
Study Design:
Cross-sectional cohort.
Setting & Participants:
45 maintenance hemodialysis patients and 67 controls without reported kidney disease, both without history of known stroke.
Predictor:
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).
Outcomes:
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.
Measurements:
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).
Limitations:
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.
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