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Correlation of hippocampal atrophy with hyperhomocysteinemia in hemodialysis patients: An exploratory pilot study
Kyoko Maesato1, Takayasu Ohtake1, Yasuhiro Mochida1
1Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital Kamakura, Kanagawa, Japan.
Insights
Cognitive impairment is a concern for hemodialysis (HD) patients. This study found hyperhomocysteinemia is linked to hippocampal atrophy in HD patients, while age impacts whole-brain atrophy.
Area of Science:
- Nephrology
- Neurology
- Radiology
Background:
- Cognitive impairment is a significant issue for patients undergoing hemodialysis (HD).
- The specific factors contributing to brain atrophy in HD patients remain unclear.
- Understanding these factors is crucial for managing neurological complications in HD patients.
Purpose of the Study:
- To investigate the association between brain atrophy and various clinical factors in HD outpatients.
- To quantitatively assess hippocampal and whole-brain atrophy using MRI.
- To identify independent determinants of brain atrophy in this population.
Main Methods:
- Brain MRI scans were acquired for 34 HD outpatients.
- Voxel-based Specific Regional Analysis System for Alzheimer's Disease (VSRAD) software was used for quantitative atrophy assessment.
- Correlation and multiple regression analyses were performed to identify contributing factors.
Main Results:
- The mean extent of hippocampal atrophy was 27.3% and whole-brain atrophy was 11.2%.
- Hippocampal atrophy correlated with low BMI, high total serum homocysteine (tHcy), and elevated brachial-ankle pulse wave velocity (baPWV).
- Age and hypoalbuminemia were associated with whole-brain atrophy, with age being an independent determinant. Hyperhomocysteinemia (tHcy) was an independent determinant of hippocampal atrophy.
Conclusions:
- Hyperhomocysteinemia is significantly associated with hippocampal atrophy in hemodialysis patients.
- Age is a key determinant of whole-brain atrophy in this cohort.
- Further research is warranted to explore interventions targeting these factors.
Background:
Cognitive impairment is one of the important critical issues in hemodialysis (HD) patients. However, the associating factors of brain atrophy in HD patients have not been fully elucidated.
Purpose And Methods:
Brain magnetic resonance imaging (MRI) was performed in 34 of total 72 HD outpatients in our dialysis center. These MRI images were analyzed by an application software; Voxel-based Specific Regional Analysis System for Alzheimer's Disease (VSRAD). VSRAD quantitatively calculates the extent of brain atrophy (percent of volume reduction) comparing with a MRI imaging database of 80 age-matched healthy controls. The extent of both hippocampal and whole-brain atrophy was evaluated with possible contributing factors.
Results:
In all patients, the mean extent of hippocampal atrophy was 27.3%, and the mean extent of whole-brain atrophy was 11.2%. The extent of hippocampal atrophy was significantly correlated with low body mass index (BMI), total serum homocysteine (tHcy) levels, and brachial-ankle pulse wave velocity (baPWV). The extent of whole-brain atrophy showed significant correlations with age, hypoalbuminemia, and baPWV. Based on the multiple regression analysis, tHcy was an independent determinant of hippocampal atrophy (β = 0.460, R2 = 0.189, P<0.01); while age was an independent determinant of whole-brain atrophy (β = 0.594, R2 = 0.333, P<0.01).
Conclusions:
In this exploratory pilot study, hippocampal atrophy was significantly correlated with hyperhomocysteinemia in HD patients.