Hippocampal subfield morphology in regular hemodialysis patients

Abstract

Background Hippocampal alterations have been implicated in the pathophysiology of cognitive impairment in hemodialysis patients. The hippocampus consists of several distinct subfields, and the molecular mechanisms underlying cognition might be associated with specific hippocampal subfield volume changes. However, this has not yet been investigated in hemodialysis patients. This study aimed to explore volumetric abnormalities in hippocampal subfields in regular hemodialysis patients. Methods High-resolution T1-weighted structural images were collected in 61 subjects including 36 hemodialysis patients and 25 healthy controls. A state-of-the-art hippocampal segmentation approach was adopted to segment the hippocampal subfields. Group differences in hippocampal subfield volumes were assessed in Python with a statsmodels module using an ordinary least squares regression with age and sex as nuisance effects. Results Hemodialysis patients had significantly smaller volumes in the bilateral hippocampus (p < 0.05/2, Bonferroni corrected), CA (cornu ammonis) 1, CA4, granule cell and molecular layer of the dentate gyrus, hippocampus-amygdala-transition-area and molecular layer of the hippocampus than healthy controls (p < 0.05/24, Bonferroni corrected). Hemodialysis patients also had lower volumes in the left hippocampal tail and right fimbria than healthy controls (p < 0.05/24, Bonferroni corrected). Hippocampal subfield volumes were associated with neuropsychological test scores, the duration of disease and hemoglobin levels. Conclusions We found smaller hippocampal subfield volumes in hemodialysis patients, which were associated with impaired cognition, supporting their role in memory disturbance in the hemodialysis population. However, multiple clinical factors may have confounded the results, and therefore, the interpretation of these results needs to be cautious.

Cognitive Impairment and Brain Atrophy in Patients with Chronic Kidney Disease

“…On the other hand, it has been shown that cerebral atrophy progresses rapidly in patients with CKD, especially in dialysis patients [ 12 , 13 , 14 , 15 , 16 , 17 ]. Brain atrophy is significantly associated with CI, and atrophy of the frontal lobe and hippocampus is more remarkable in such patients [ 13 , 18 , 19 ].…”

Chronic kidney disease causes blood-brain barrier breakdown via urea-activated matrix metalloproteinase-2 and insolubility of tau protein

“…CKD results in the accumulation of both salt and water in the body and might be a risk factor correlated with AD onset and cognitive impairment [ 15 ]. A recent study identified that smaller hippocampal volumes in hemodialysis patients were associated with impaired cognition [ 16 ]. In addition, a recent Mendelian randomization study revealed that CKD alters the brain cortical structure, including a reduction in cortical thickness, indicating neurodegeneration due to kidney damage [ 17 ].…”