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

• Published in: European radiology Vol. 29; no. 3; pp. 1415 - 1424
• Main Authors: Cheng, Ben-Chung, Chen, Po-Cheng, Chen, Pei-Chin, Lu, Cheng-Hsien, Huang, Yu-Chi, Chou, Kun-Hsien, Li, Shau-Hsuan, Lin, An-Ni, Lin, Wei-Che
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2019; Springer Nature B.V
• Subjects: Anemia; Blood flow; Brain; Brain - diagnostic imaging; Brain - physiopathology; Cerebral blood flow; Cerebrovascular Circulation - physiology; Cognition; Cognition - physiology; Cognitive ability; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - etiology; Cognitive Dysfunction - physiopathology; Diagnostic Radiology; Dialysis; End-stage renal disease; Executive function; Female; Hematocrit; Hemoglobin; Hippocampus; Humans; Imaging; Impairment; Internal Medicine; Interventional Radiology; Kidney diseases; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Magnetic Resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicare; Medicine; Medicine & Public Health; Middle Aged; Neuroimaging; Neuropsychological Tests; Neuroradiology; NMR; Nuclear magnetic resonance; Patients; Perfusion; Peritoneal Dialysis; Peritoneum; Putamen; Radiology; Spin labeling; Spin Labels; Ultrasound; Spin labelling; Cerebral blood flow; Peritoneal dialysis; Arteries; Cognitive impairment
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-018-5675-9

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.