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Cerebral microbleeds and their influence on cognitive impairment in Dialysis patients
Yujun Qian1, Ke Zheng2, Haiyun Wang1
1Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital (East), No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Abstract:
Cerebral microbleeds (CMBs) in dialysis patients have recently attracted much attention, and the different locations of CMBs indicate different pathological processes. Previous studies on the relationship between CMBs and cognitive impairment (CI) in the general population and in dialysis patients have reported controversial results. A total of 180 chronic dialysis patients were enrolled in our study. Based on brain magnetic resonance imaging (MRI) analysis of CMBs, the patients were divided into 4 groups (without-CMBs group, strictly lobar group, strictly deep group, and mixed group). A wide range of cognitive tests was administered to evaluate cognitive function. The risk factors for CMBs were explored, and the correlation between CMB distribution and CI was investigated by regression analysis. The prevalence of CMBs was 32.8% in the total study population, 36.1% in the haemodialysis (HD) subgroup and 26.2% in the peritoneal dialysis (PD) PD subgroup. Sixteen subjects (8.9%) were classified as the lobar group, 12 subjects (6.7%) as the mixed group, and 31 subjects (17.2%) as the deep group. A significant association was shown between deep CMBs and impaired cognitive function, involving overall cognitive function, memory, language ability and executive function. Deep CMBs were significantly associated with dialysis vintage, mean arterial pressure (MAP) and lacunar infarcts number, while deep CMBs showed no correlation with dialysis modality and current heparin medication. Deep CMBs are closely associated with global and specific CI in dialysis patients. Blood pressure control may prevent deep CMBs and their associated CI.
Insights
Deep cerebral microbleeds (CMBs) are linked to cognitive impairment in dialysis patients. Controlling blood pressure may help prevent these microbleeds and associated cognitive decline.
Area of Science:
- Neurology
- Nephrology
- Radiology
Background:
- Cerebral microbleeds (CMBs) are increasingly recognized in dialysis patients, with varied locations suggesting different pathologies.
- Previous research on CMBs and cognitive impairment (CI) in dialysis patients yielded conflicting results.
Purpose of the Study:
- To investigate the association between the distribution of CMBs and cognitive function in chronic dialysis patients.
- To identify risk factors for CMBs and explore their correlation with CI.
Main Methods:
- 180 chronic dialysis patients underwent brain MRI for CMB detection and cognitive testing.
- Patients were categorized into four groups based on CMB location: none, strictly lobar, strictly deep, and mixed.
- Regression analysis was used to examine risk factors and the relationship between CMB distribution and CI.
Main Results:
- The prevalence of CMBs was 32.8% overall, higher in hemodialysis (36.1%) than peritoneal dialysis (26.2%).
- Deep CMBs were significantly associated with impaired overall cognitive function, memory, language, and executive function.
- Deep CMBs correlated with dialysis vintage, mean arterial pressure (MAP), and lacunar infarcts, but not dialysis modality or heparin use.
Conclusions:
- Deep CMBs are closely associated with global and specific cognitive impairments in dialysis patients.
- Effective blood pressure management may be crucial in preventing deep CMBs and their subsequent cognitive decline.
