More rapid progression of brain atrophy in patients on peritoneal dialysis compared with hemodialysis: The VCOHP Study

Cognitive Impairment and Brain Atrophy in Patients with Chronic Kidney Disease

“…Although numerous studies have explored cognitive function in PD and HD patients, our study stands out as the first to directly compare brain volume and the progression of brain atrophy [ 30 , 31 , 32 , 33 , 34 ]. Surprisingly, our findings contradict those of many studies indicating superior cognitive function in PD patients [ 27 ].…”

“…In recent years, it has been reported that the brain gray matter volume (GMV) and GMV ratio (GMR) decrease with age, but the white matter volume (WMV) and WMV ratio (WMR) remain unchanged, as revealed through the analysis of brain MRI using statistical parametric mapping (SPM) [ 25 ]. Subsequently, we conducted an analysis using SPM on brain MRI data from patients with ND, PD, and HD, comparing both brain volume and the rate of change [ 26 , 27 ].…”

Brain atrophy in patients on peritoneal dialysis treatment

“…Before arriving at the conclusion of the current study that the decline in brain volume was faster in PD patients than in HD patients [8], Tsuruya et al might have hypothesized that it could be prevented in PD patients, but not HD patients, since it has been considered that brain hypoperfusion during HD sessions likely plays a role in brain atrophy in HD patients [5,6]. Indeed, a significant relationship has previously been reported between the number of dialysisrelated hypotension episodes and changes in frontal brain volume, suggesting that dialysis-related hypotension may play a role in the progression of frontal lobe atrophy in HD patients [5,6].…”

“…In contrast, a longitudinal analysis revealed that age-and sexadjusted brain volumes at baseline and after two years were significantly lower in PD patients than in HD patients. They also showed that the annual decrease in brain volume was significantly greater in PD patients than in HD patients, even after adjusting for potential confounding factors, including age, sex, diabetes mellitus, a history of cardiovascular disease, smoking habits, systolic blood pressure, hemoglobin concentration, baseline brain volume, and logtransformed brain natriuretic peptide [8]. This study is interesting in terms of the fact that it is the first detailed report comparing brain atrophy between PD and HD patients, while the findings may be somewhat surprising given the therapeutic nature of PD.…”

“…Tsuruya et al focused on this concern in their study, "Faster brain atrophy in patients on peritoneal dialysis compared with hemodialysis: The VCOHP Study," published in the current issue of Hypertension Research [8]. In this study, they examined not only the brain volume, which was standardized by determining the percentages of gray matter to total intracranial volume, but also its annual change in patients on PD, and compared the findings with those in patients on HD in both cross-sectional and longitudinal analyses.…”