Anatomic Brain Disease in Hemodialysis Patients: A Cross-sectional Study

Abstract

Background Although dialysis patients are at high risk for stroke and have a high burden of cognitive impairment, there are few reports on anatomic brain findings in the hemodialysis population. Using brain magnetic resonance imaging (MRI), we compared the prevalence of brain abnormalities in hemodialysis patients to 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 prior history of known stroke. Predictor The primary predictor was dialysis status. Covariates included demographics (age, race, sex), vascular risk factors (diabetes and hypertension) and cardiovascular disease (coronary artery disease, congestive heart failure). Outcomes Brain MRI features including severity of white matter disease and cerebral atrophy (sulcal prominence and ventricular atrophy), hippocampal size, and small/large vessel infarcts. Measurements Semi-quantitative scale (0-9 for white matter disease and cerebral atrophy, 0-3 for hippocampal size) and infarct prevalence. Results The mean age of hemodialysis patients and controls was 55 ± 17 (SD) and 53 ± 13 years, respectively. In comparison with controls, hemodialysis patients had more severe white matter disease (1.6 v 0.7) and cerebral atrophy (sulcal prominence = 2.3 v 0.6; ventricular enlargement = 2.3 v 0.9; hippocampal size = 1.3 v 1.0) with all p-values <0.001. In multivariable analyses, hemodialysis status was independently associated 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 is likely healthier than the overall US hemodialysis population, partly limiting generalizability. Conclusions Hemodialysis patients have more white matter disease and cerebral atrophy compared to controls without known kidney disease. Hemodialysis patients also have a high prevalence of unrecognized infarcts.

Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation

“…These older patients on hemodialysis are likely at high risk of developing and being diagnosed with dementia and Alzheimer's disease given that they have worse cognitive function than the general population (14,15), have a greater burden of white matter disease and cerebral atrophy (16), experience significant decline in cognitive function while undergoing hemodialysis (17), and have a high burden of cognitive impairment even at younger ages (17)(18)(19). Executive function is the domain of cognition most affected by hemodialysis within the first 2 years after initiation (18), and impairments in executive function are early signs of dementia and Alzheimer's disease (20,21).…”

Analysis of Risk Factors for Development of Cognitive Disorders in Maintenance Hemodialysis Patients – Pilot Study

“…Anatomically, in hemodialysis patients' population more frequent is cerebral atrophy, hippocampal atrophy and silent ischemia (31). Taken that predominantly executive and orientation function are affected; it is indicated that risk factors are the same as in vascular diseases (4).…”

Vitamin D

“…The study by Drew et al (9) found significantly greater degrees of cerebral and hippocampal atrophy, typical findings in Alzheimer's disease, as well as greater numbers of infarcts in the hemodialysis patients compared with controls.…”

“…Drew et al (9) also recently reported results of brain magnetic resonance imaging (MRI) in 45 hemodialysis patients compared with 67 controls in a younger subsample (mean555 years) of the same population (9). The study by Drew et al (9) found significantly greater degrees of cerebral and hippocampal atrophy, typical findings in Alzheimer's disease, as well as greater numbers of infarcts in the hemodialysis patients compared with controls.…”