Structural brain changes in patients who receive different durations of hemodialysis

Document Type : Original Article

Authors

1 Department of Clinical Psychology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran

2 Associate Professor of Nephrology, Department of Nephrology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran

3 Professor of Clinical Psychology, Department of Clinical Psychology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran

4 Associate Professor of Radiology, Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran

5 Health Information Management Department, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran

6 National Institute for Medical Research Development (NIMAD), Tehran, Iran

Abstract

Background: Hemodialysis patients are particularly vulnerable to cerebral vascular disease. Both hemodialysis duration and cerebral small vessel disease are crucial in this patient population, and additional research is necessary to further understand their relationship.
Objectives: This study aimed to investigate the structural brain changes in patients who receive different durations of hemodialysis.
Methods: We recruited a total of 80 hemodialysis patients and categorized them into two groups to scrutinize the effects of hemodialysis treatment. Group 1 included 41 patients who received hemodialysis for more than six months, and Group 2 consisted of 39 patients who underwent hemodialysis treatment for less than six months. The structural and vascular modifications of the brain in these two groups were studied using a 1.5 Tesla MRI machine to perform brain scans by our research team.
Results: Patients who underwent hemodialysis treatment for a more extended period, with a median treatment duration of up to 4 years, showed minor vessel disease, compared to those who received hemodialysis for a shorter period of 3 to 5 months. The ischemic effects were predominantly found in areas such as the pre-ventricular, subcortical, and white matter, with mean± SD of 1.33±0.471, 1.23±0.420, and 1.39±0.490, respectively. Additionally, we identified other brain abnormalities, such as pons irregularities, global brain atrophy, thinning in the corpus callosum, and frontal lobe atrophy, with a significant value of P<0.01).
Conclusion: The study indicates that extended periods of hemodialysis reveal discernible signs of subcortical and periventricular white matter disease among patients. This finding provides critical insight into the potential long-term impacts of hemodialysis treatment, highlighting the need for further investigation and advanced treatment measures.

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Main Subjects

References

  1. Gerrits T, Brouwer IJ, Dijkstra KL, Wolterbeek R, Bruijn JA, Scharpfenecker M, et al. Endoglin Is an Important Mediator in the Final Common Pathway of Chronic Kidney Disease to End-Stage Renal Disease. Int J Mol Sci. 2023; 24(1):646. doi:10.3390/ijms24010646 PMid:36614087 PMCid:PMC9820946
  2. Gerasimoula K, Lefkothea L, Maria L, Victoria A, Paraskevi T, Maria P. Quality of life in hemodialysis patients. Mater Sociomed. 2015;27(5):305. doi:10.5455/msm.2015.27.305-309 PMid:26622195 PMCid:PMC4639348
  3. Hemati Z, Alidosti M, Sharifirad G, Kargar M. The relationship between depression and quality of life among hemodialysis patients in Chaharmahal and Bakhtiari province in the year 2011. J Educ Health Promot. 2013;2(1):6. doi:10.4103/2277-9531.106645 PMid:24083256 PMCid:PMC3778638
  4. Shahgholian N, Yousefi H. Supporting hemodialysis patients: A phenomenological study. Iran J Nurs Midwifery Res. 2015;20(5):626. doi:10.4103/1735-9066.164514 PMid:26457103 PMCid:PMC4598912
  5. Wang H, Han X, Li M, Yang Z-H, Liu W-H, Wang Z-C. Long-term hemodialysis may affect enlarged perivascular spaces in maintenance hemodialysis patients: evidence from a pilot MRI study. Quant Imag Med Surg. 2022;12(1): 341. doi:10.21037/qims-20-1246 PMid:34993083 PMCid:PMC8666746
  6. Traykov L, Baudic S, Thibaudet M-C, Rigaud A-S, Smagghe A, Boller F. Neuropsychological deficit in early subcortical vascular dementia: comparison to Alzheimer's disease. Dement Geriatr Cogn Disord. 2002;14(1):26-32. doi:10.1159/000058330 PMid:12053129
  7. Román GC. Vascular dementia: distinguishing characteristics, treatment, and prevention. J Am Geriatr Soc. 2003;51(5s2). doi:10.1046/j.1532-5415.5155.x PMid:12801386
  8. Khatri M, Wright CB, Nickolas TL, Yoshita M, Paik MC, Kranwinkel G, et al. Chronic kidney disease is associated with white matter hyperintensity volume. Stroke. 2007;38(12):3121-6. doi:10.1161/STROKEAHA.107.493593 PMid:17962588 PMCid:PMC2948438
  9. Drew DA, Bhadelia R, Tighiouart H, Novak V, Scott TM, Lou KV, et al. Anatomic brain disease in hemodialysis patients: a cross-sectional study. Am J Kidney Dis. 2013;61(2):271-8. doi:10.1053/j.ajkd.2012.08.035 PMid:23040011 PMCid:PMC3546146
  10. Junn JC, Soderlund KA, Glastonbury CM, editors. Imaging of head and neck cancer with CT, MRI, and US. Semin Nuc Med; 2021: Elsevier. doi:10.1053/j.semnuclmed.2020.07.005 PMid:33246537
  11. Zhang LJ, Wen J, Ni L, Zhong J, Liang X, Zheng G, et al. Predominant gray matter volume loss in patients with end-stage renal disease: a voxel-based morphometry study. Metab Brain Dis. 2013;28 (4): 647-54. doi:10.1007/s11011-013-9438-7 PMid:24065440
  12. Chai C, Zhang M, Long M, Chu Z, Wang T, Wang L, et al. Increased brain iron deposition is a risk factor for brain atrophy in patients with haemodialysis: a combined study of quantitative susceptibility mapping and whole brain volume analysis. Metab Brain Dis. 2015;30(4):1009-16. doi:10.1007/s11011-015-9664-2 PMid:25796223
  13. Chai C, Yan S, Chu Z, Wang T, Wang L, Zhang M, et al. Quantitative measurement of brain iron deposition in patients with haemodialysis using susceptibility mapping. Metab Brain Dis. 2015;30(2):563-71. doi:10.1007/s11011-014-9608-2 PMid:25182196
  14. Zhang R, Liu K, Yang L, Zhou T, Qian S, Li B, et al. Reduced white matter integrity and cognitive deficits in maintenance hemodialysis ESRD patients: a diffusion-tensor study. Eur Radiol. 2015;25(3):661-8. doi:10.1007/s00330-014-3466-5 PMid:25326436
  15. Tamadon MR, Adibimehr AR, Ghorbani R. Cognitive Impairment in Dialysis and Non-Dialysis Patients Suffering from Chronic Renal Failure and Comparing Them with a Control Group. Middle East J Rehabil Health Stud. 2017. doi:10.5812/mejrh.12815
  16. Vermeer SE, Hollander M, van Dijk EJ, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and white matter lesions increase stroke risk in the general population. Stroke. 2003;34(5): 1126-9. doi:10.1161/01.STR.0000068408.82115.D2 PMid:12690219
  17. Seliger SL, Gillen DL, Longstreth W, Kestenbaum B, Stehman-Breen CO. Elevated risk of stroke among patients with end-stage renal disease. Kidney Int. 2003;64(2):603-9. doi:10.1046/j.1523-1755.2003.00101.x PMid:12846756
  18. Yaffe K, Ackerson L, Tamura MK, Le Blanc P, Kusek JW, Sehgal AR, et al. Chronic kidney disease and cognitive function in older adults: findings from the chronic renal insufficiency cohort cognitive study. J Am Geriatr Soc. 2010; 58(2):338-45. doi:10.1111/j.1532-5415.2009.02670.x PMid:20374407 PMCid:PMC2852884
  19. Sarnak MJ, Tighiouart H, Scott TM, Lou KV, Sorensen EP, Giang LM, et al. Frequency of and risk factors for poor cognitive performance in hemodialysis patients. Neurology. 2013;80(5):471-80. doi:10.1212/WNL.0b013e31827f0f7f PMid:23303848 PMCid:PMC3590049
  20. Grundman M, Jack CR, Petersen RC, Kim HT, Taylor C, Datvian M, et al. Hippocampal volume is associated with memory but not nonmemory cognitive performance in patients with mild cognitive impairment. J Mol Neurosci. 2003;20(3):241-8. doi:10.1385/JMN:20:3:241 PMid:14501003
  21. Wolf H, Grunwald M, Kruggel F, Riedel-Heller S, Angerhöfer S, Hojjatoleslami A, et al. Hippocampal volume discriminates between normal cognition; questionable and mild dementia in the elderly. Neurobiol Aging. 2001;22(2):177-86. doi:10.1016/S0197-4580(00)00238-4 PMid:11182467
  22. Fukunishi I, Kitaoka T, Shirai T, Kino K, Kanematsu E, Sato Y. Psychiatric disorders among patients undergoing hemodialysis therapy. Nephron. 2002;91(2):344-7. doi:10.1159/000058418 PMid:12053079
  23. Čengič B, Resic H. Depression in hemodialysis patients. Bosn J Basic Med Sci. 2010;10(Suppl 1):S73. doi:10.17305/bjbms.2010.2653 PMid:20433436 PMCid:PMC5627718
  24. Anees M, Barki H, Masood M, Ibrahim M, Mumtaz A. Depression in hemodialysis patients. Pak J Med Sci. 2008;24(4):560-5.
  25. Jiménez-Sánchez L, Hamilton OK, Clancy U, Backhouse EV, Stewart CR, Stringer MS, et al. Sex differences in cerebral small vessel disease: a systematic review and meta-analysis. Front Neurol. 2021:1960. doi:10.1101/2021.03.04.21252853
  26. Pavlovic A, Pekmezovic T, Mijajlovic M, Tomic G, Trajkovic JZ. Is the female sex associated with an increased risk for long-term cognitive decline after the first-ever lacunar stroke? Prospective study on small vessel disease cohort. Neuroepidemiology. 2022;13. doi:10.3389/fneur.2022.1052401 PMid:36712431 PMCid:PMC9878188
  27. Hamilton OK, Backhouse EV, Janssen E, Jochems AC, Maher C, Ritakari TE, et al. Cognitive impairment in sporadic cerebral small vessel disease: a systematic review and meta‐analysis. Alzheimers Dement. 2021;17(4):665-85. doi:10.1002/alz.12221 PMid:33185327 PMCid:PMC8593445
  28. Finger CE, Moreno-Gonzalez I, Gutierrez A, Moruno-Manchon JF, McCullough LD. Age-related immune alterations and cerebrovascular inflammation. Mol Psychiaty. 2022; 27 (2): 803-18. doi:10.1038/s41380-021-01361-1 PMid:34711943 PMCid:PMC9046462
  29. Saez-Atienzar S, Masliah E. Cellular senescence and Alzheimer disease: the egg and the chicken scenario. Nat Rev Neurosci. 2020; 21(8):433-44. doi:10.1038/s41583-020-0325-z PMid:32601397
  30. Zhuo Z, Tian D, Duan Y, Li R, Bai Y, Shi Y, et al. Periventricular diffusion gradient of normal-appearing white matter and its transcriptional signatures in normal aging and multiple neurological diseases. 2022. doi:10.21203/rs.3.rs-2224463/v1
  31. Guan J, Li Q, Dai Z, Lai L, Sun S, Geng Y, et al. Quantitative morphometric changes in vascular mild cognitive impairment patients: early diagnosis of dementia. Cereb Cortex. 2023. doi:10.1093/cercor/bhac437 PMid:36635220 PMCid:PMC10152087
  32. Chen S, Wu H, Song Y, Ge H, Yan Z, Xue C, et al. Altered structural and functional homotopic connectivity associated with the progression from mild cognitive impairment to Alzheimer's disease. Psychiat Res. 2023;319:115000. doi:10.1016/j.psychres.2022.115000 PMid:36502711
  33. Chen J, Ge A, Zhou Y, Ma Y, Zhong S, Chen C, et al. White matter integrity mediates the associations between white matter hyperintensities and cognitive function in patients with silent cerebrovascular diseases. CNS Neurosci Ther. 2023;29(1):412-28. doi:10.1111/cns.14015 PMid:36415139 PMCid:PMC9804066
  34. Ziccardi S, Pizzini FB, Guandalini M, Tamanti A, Cristofori C, Calabrese M. Making visible the invisible: automatically measured global and regional brain volume is associated with cognitive impairment and fatigue in multiple sclerosis. Bioengineering. 2023;10(1):41. doi:10.3390/bioengineering10010041 PMid:36671613 PMCid:PMC9855175
Journal of Preventive and Complementary Medicine
Volume 2, Issue 4
September 2023
Pages 202-208

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History

  • Receive Date: 16 July 2023
  • Revise Date: 26 August 2023
  • Accept Date: 21 September 2023

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