Association between susceptibility value and cerebral blood flow in the bilateral putamen in patients undergoing hemodialysis

Abstract

Hemodialysis (HD) is the most regularly applied replacement therapy for end-stage renal disease, but it may result in brain injuries. The correlation between cerebral blood flow (CBF) alteration and iron deposition has not been investigated in patients undergoing HD. Ferritin level may be a dominant factor in CBF and iron deposition change. We hypothesize that ferritin level might be the key mediator between iron deposition and CBF alteration. The correlation in the putamen was estimated between the susceptibility values and CBF in patients undergoing HD. Compared with healthy controls, patients showed more altered global susceptibility values and CBF. The susceptibility value was negatively correlated with CBF in the putamen in patients. Moreover, the susceptibility value was negatively correlated with ferritin level and positively correlated with serum iron level in the putamen of patients. CBF was positively correlated with ferritin level and negatively correlated with serum iron level in the putamen of patients. These findings indicate that iron dyshomeostasis and vascular damage might exist in the putamen in patients. The results revealed that iron dyshomeostasis and vascular damage in the putamen may be potential neural mechanisms for neurodegenerative processes in patients undergoing HD.

Dysfunctional Coupling of Cerebral Blood Flow and Susceptibility Value in the Bilateral Hippocampus is Associated with Cognitive Decline in Nondialysis Patients with CKD

“…In our previous study, hemodialysis patients showed changed global susceptibility values in the primary motor cortex, salience network, and limbic system. 38 In this study, higher susceptibility values in the bilateral putamen and caudate and lower susceptibility values in the bilateral hippocampus, thalamus, and fusiform gyrus were found in the CKD 5ND group compared with the HC group. The pattern of iron deposition in patients with CKD 5ND was completely different from that in patients undergoing maintenance hemodialysis.…”

“…The pattern of iron deposition in patients with CKD 5ND was completely different from that in patients undergoing maintenance hemodialysis. 38 Because patients with ESKD are affected by renal anemia, iron agents and recombinant human erythropoietin are frequently used to promote erythropoiesis and maintain normal target levels of hematocrit and hemoglobin. This may lead to systemic iron overload and subsequent iron transport into the brain.…”

“…The QSM reconstruction methods were described in our previous studies. 38,44 All QSM images were visually inspected to screen for artifacts. First, the raw phase was unwrapped using Laplacian‐based phase unwrapping.…”

“…37 In addition, our another study showed that increased iron deposition in the putamen was accompanied by decreased CBF in patients undergoing hemodialysis. 38 It remains unclear whether cognitive decline is related to the underlying disease or the hemodialysis treatment they undergo. Cerebral perfusion and iron deposition of each voxel can be separately represented by CBF and susceptibility value maps, and the correlation between them can be analyzed to represent vascular–metabolic coupling.…”