Decreased cerebral blood flow and improved cognitive function in patients with end-stage renal disease after peritoneal dialysis: An arterial spin-labelling study

Abstract

Objectives The aim of this study was to evaluate the relationship between cognitive impairment and brain perfusion using arterial spin labelling (ASL) in end-stage renal disease (ESRD) patients undergoing PD. Methods ESRD patients undergoing PD were recruited. Laboratory screening, neuropsychological tests and ASL magnetic resonance imaging (MRI) were conducted prior to and after 6 months of PD. Age- and sex-matched normal subjects without ESRD served as the control group. Comparisons of regional CBF between ESRD patients before or after undergoing PD and normal controls were performed. Correlations between biochemical, neuropsychological and CBF data were also conducted to evaluate the relationships. Results ESRD patients showed poor performance in many of the neuropsychological tests; PD improved cognition in some domains. Pre-PD patients had higher mean CBF than post-PD patients and normal controls, but no significant difference was found between the normal controls and post-PD patients. Negative correlations were observed pre-PD (regional CBF in left hippocampus vs. perseverative responses, r = -0.662, p = 0.014), post-PD (mean CBF vs. haemoglobin level, r = -0.766, p = 0.002), and before and after PD (change in CBF in the left putamen vs. change in haematocrit percentage, r = -0.808, p = 0.001). Conclusion Before PD, ESRD patients had increased cerebral perfusion that was related to poorer executive function, especially in the left hippocampus. Post-PD patients performed better in some cognitive test domains than pre-PD patients. The degree of anaemia, i.e., haemoglobin level or haematocrit percentage, might predict cognitive impairment in PD patients. Key Points • In this study, ESRD patients before PD had cerebral hyperperfusion that was related to poorer executive function. • Post-PD patients performed better in some cognitive test domains than pre-PD patients did. • The degree of anaemia might predict cognitive impairment in PD patients. Electronic supplementary material The online version of this article (10.1007/s00330-018-5675-9) contains supplementary material, which is available to authorized users.

Disturbed neurovascular coupling in hemodialysis patients

“…For example, hemodialysis patients exhibited decreased CBF in the right olfactory cortex and anterior cingulate gyrus, and decreased ALFF in the bilateral precuneus and superior frontal gyrus, most of which were components of the DMN. Several DMN-related regions showed decreased CBF in the inferior and middle frontal lobes, inferior temporal and parietal lobes (Cheng et al, 2019;Papoiu et al, 2014), decreased regional homogeneity in the bilateral frontal, parietal and temporal lobes , decreased gray matter volume in the bilateral precuneus and right frontal lobe , reported by previous studies. Moreover, DMN-related decreases of functional connectivity have also been identified in hemodialysis patients, such as between medial prefrontal cortex and posterior cingulate cortex and precuneus (Ling et al, 2014).…”

“…Using endogenous contrast, ASL is a non-invasive technique that can quantify CBF in a given time and explore the altered CBF in hemodialysis patients. Hemodialysis patients exhibited increased or decreased CBF in widespread regions of the brain, particularly decreased CBF in the prefrontal cortex (Cheng et al, 2019;Papoiu et al, 2014).…”

Alterations of Spontaneous Brain Activity in Hemodialysis Patients

“…Similarly, higher regional homogeneity was also found in the previous study (Li et al, 2018 ). The hyperactivity of the left hippocampus might be associated with hyper-perfusion in this region found by Cheng et al ( 2019 ) in a recent study. Together with the findings described above, we may deduce that the abnormality in the parahippocampus/hippocampus may be involved in the memory deficits in hemodialysis ESRD patients.…”

“…Luo et al ( 2016 ) also found that elevated serum urea and decreased hemoglobin levels have an influence on intrinsic brain activity in peritoneal dialysis patients with ESRD. Increasing evidence has suggested that anemia in patients with ESRD might lead to cerebral hyper-perfusion, which finally results in cognitive dysfunction (Jiang et al, 2016 ; Cheng et al, 2019 ). The neurophysiological performance could be improved after anemia treatment (Kambova, 1998 ; Pickett et al, 1999 ; Kurella Tamura and Yaffe, 2011 ).…”

Peer Review #1 of "Disturbed neurovascular coupling in hemodialysis patients (v0.1)"

“…Using endogenous contrast, ASL is a noninvasive technique that can quantify CBF in a given time and explore the altered CBF in hemodialysis patients. Hemodialysis patients exhibited increased or decreased CBF in widespread regions of the brain, particularly decreased CBF in the prefrontal cortex (Cheng et al 2019;Papoiu et al 2014).…”