Systematic Review of Structural and Functional Neuroimaging Findings in Children and Adults with CKD

Abstract

Summary CKD has been linked with cognitive deficits and affective disorders in multiple studies. Analysis of structural and functional neuroimaging in adults and children with kidney disease may provide additional important insights into the pathobiology of this relationship. This paper comprehensively reviews neuroimaging studies in both children and adults. Major databases (PsychLit, MEDLINE, WorldCat, ArticleFirst, PubMed, Ovid MEDLINE) were searched using consistent search terms, and studies published between 1975 and 2012 were included if their samples focused on CKD as the primary disease process. Exclusion criteria included case reports, chapters, and review articles. This systematic process yielded 43 studies for inclusion (30 in adults, 13 in children). Findings from this review identified several clear trends: (1) presence of cerebral atrophy and cerebral density changes in patients with CKD; (2) cerebral vascular disease, including deep white matter hyperintensities, white matter lesions, cerebral microbleeds, silent cerebral infarction, and cortical infarction, in patients with CKD; and (3) similarities in regional cerebral blood flow between patients with CKD and those with affective disorders. These findings document the importance of neuroimaging procedures in understanding the effect of CKD on brain structure, function, and associated behaviors. Results provide a developmental linkage between childhood and adulthood, with respect to the effect of CKD on brain functioning across the lifespan, with strong implications for a cerebrovascular mechanism contributing to this developmental linkage. Use of neuroimaging methods to corroborate manifest neuropsychological deficits or perhaps to indicate preventive actions may prove useful to individuals with CKD.

Abnormal Intrinsic Brain Activity Patterns in Patients with End-Stage Renal Disease Undergoing Peritoneal Dialysis: A Resting-State Functional MR Imaging Study

“…Authors of these studies did not investigate the effect of the specific dialysis modality on spontaneous brain activity in patients with ESRD, because they included patients undergoing hemodialysis and PD and those not undergoing dialysis. In addition, most previous studies have been focused on abnormal gray and white brain matter structures (16,(22)(23)(24)(25)(26). Several studies (2,7,8) included patients with ESRD undergoing hemodialysis and PD, which can have a confounding effect on the study results.…”

Cognitive impairment and hippocampal atrophy in chronic kidney disease

“…A few studies have reported brain atrophy and WMH burden in patients with CKD or renal failure . A meta‐analysis of numerous structural and functional neuroimaging studies that examined children and adults with CKD identified several clear trends, including cerebral atrophy, WMH, cerebral infarction, microbleeding, and cerebral blood flow pattern with affective disorders . In the retrospective population‐based Rotterdam Scan Study, subjects with low eGFR had smaller brain and deep WM volumes and more WMH .…”

Association of Kidney Function Biomarkers with Brain MRI Findings: The BRINK Study

“…There is a strong graded cross- sectional relation between eGFR and cognitive function in patients with CKD as renal function declines below eGFR of 60 ml/min/1.73 m 2 [2–5]. Previous structural magnetic resonance imaging (MRI) studies in non-dialysis CKD patients have reported variable prevalence of vascular pathologies and concomitant global and region-specific atrophy [6–9], in part due to substantive differences in patient populations and range of CKD severity. Most CKD cohort studies have primarily included patients with mild CKD (Stage 3a: eGFR 45–59 ml/min/1.73 m 2 ) rather than those with lower renal function (Stages 3b-5: eGFR <45 ml/min/1.73 m 2 ) who are at higher risk of both cognitive impairment and brain pathology.…”