Brain Structure Damage In Patients With End-stage Renal Disease With Maintenance Hemodialysis:A Clinical Voxel Based Morphology And Diffusion Tensor Imaging Study

Objective: Using voxel based morphology and diffusion tensor imaging to explore abnormalities of brain volume and brain white matter microstructure in End Stage Renal Disease Patients(ESRD)on routine hemodialysis and to analyze the correlation between the structure abnormalities and neurocognitive function tests and clinical biochemical indexes,to provide valuable biological and imaging information for clinical intervention treatment.Materials and Methods: Twenty-nine end stage renal disease patients with maintaining hemodialysis treated in Nephrology Department Hemodialysis Center at Affiliated Zhongshan Hospital of Dalian University are collected as patients group and twenty-nine age,sex,education,anxiety,depression,sleep quality scores matched normal subjects were recruited as normal controls in this study from October 2016 to November 2017,and all participants were right-handed and none have less than six years education.Using Siemens3.0T Verio Superconducting Magnetic Resonance Apparatus,and MPRAGE sequence T1 WI brain structure image and diffusion tensor imaging technique swere performed in both patients and normal controls.Montreal Cognitive assessment scale(MoCA),Trail Making Test A(TMT_A),Pittsburgh Sleep Quality Index scale(PSQI),Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)were obtained.Within twenty four hours after the hemodialysis,collected blood of elbow to measure clinical biochemical indexes in all patients,sunch as serum creatinine,urea nitrogen,blood potassium,blood calcium,blood phosphorus and hemoglobin.The data were analyzed by VBM based on SPM12 software package and the CAT12 toolbox,Two Independent sample t test analysis was used to compare the volume of gray and white matter between the patients and normal controls,and extract the brain volume of the significant differences brain area,and Pearson correlation analysis was used for the correlation between the significant volume changes of brain gray matter and MoCA scores,TMT_A scores,clinical biochemical indexes,and P<0.05 for the difference was statistically significant.The data were analyzed by TBSS based on the PANDA toolbox,Nonparametric statistical analysis was used to compare the FA value,AD value,RD value,and MD value between the patients and normal controls,P<0.05 as a statistical test level.The correlation analysis based on the REST software package was used for the correlation between the FA value,AD value,RD value,MD value and MoCA scores,TMT_A scores,clinical biochemical indexes,and all P<0.001,extent threshold of thirty voxels.Results:1.The MoCA and TMT_A scores between between the ESRD and HC groups was statistically significant(P<0.05).2.Compared with the normal subjects,ESRD patients showed significantly decreased volume in the gray matter of the right fusiform gyrus,the right orbital medial superior frontal gyrus,the right inferior frontal triangle,the right precentral gyrus,the left postcentral gyrus,the left pretcentral gyrus,the left temporal pole superior temporal gyrus,the left middle temporal gyrus,the left middle frontal gyrus,and the left insula,and the difference was statistically significant(P<0.05,FDR correction),there was no significant difference in the white matter volume measured by VBM between the two groups(P > 0.05).3.Compared with the normal subjects,almost all WM regions had decreased FA value,increased MD value and RD value in ESRD patients,and higher AD value only in the right corona radiate,the left corona radiate,the right superior longitudinal fasciculus,and the corpus callosum genu(P<0.05).4.In ESRD patients the decreased gray matter volume of the right orbital medial superior frontal gyrus(r=0.371,P=0.023),the right precentral gyrus(r=0.442,P=0.016),the left insula(r=0.422,P=0.022),the left precentral gyrus(r=0.456,P=0.013),the left middle frontal gyrus(r=0.422,P=0.023),the right fusiform gyrus(r=0.503,P=0.005)was positively correlated with MoCA scores;the left precentral gyrus(r=-0.445,P=0.016),the right precentral gyrus(r=-0.520,P=0.004),the right inferior frontal triangle(r=-0.410,P=0.027),the left temporal pole superior temporal gyrus(r=-0.390,P=0.036),the left middle temporal gyrus(r=-0.414,P=0.025),the left insula(r=-0.508,P=0.005),the right orbital medial superior frontal gyrus(r=-0.493,P=0.007),the left middle frontal gyrus(r=-0.516,P=0.004),and the right fusiform gyrus(r=-0.554,P=0.002)was negativity correlated with TMT_A scores.5.In ESRD patients,the FA value was positively correlated with MoCA scores at the corpus callosum body,the right internal capsule anterior limb,and the left frontal white matter,and was negatively correlated with TMT_A scores at the left thalamic,the corpus callosum body,the left posterior corona radiate,the right superior corona radiate(P<0.001).The AD value was positively correlated with TMT_A scores at the left superior longitudinal fasciculus(P<0.001).The RD value was positively correlated with TMT_A scores at the left superior longitudinal fasciculus and the corpus callosum body(P<0.001).The MD value was negatively correlated with MoCA scores at the corpus callosum genu,and was positively correlated with TMT_A scores at the left superior longitudinal fasciculus and the corpus callosum body(P<0.001).Only the AD value was negatively correlated with blood potassium at the right superior longitudinal fasciculus(P<0.001).Conclusion:1.ESRD with maintaining hemodialysis may have predominantly decreased gray matter volume,which was associated with neurocognitive dysfunction.2.ESRD with maintaining hemodialysis have more diffuse brain white matter damage,which may be characterized by diffuse interstitial brain edema,WM demyelinating and damage to the structural damages to radiation and associative fibre tracts,which are correlated with cognitive dysfunction.3.Combined VBM and DTI techniques can find and detect the brain atrophy and brain white matter microstructure damage of ESRD maintenance hemodialysis patients,and may provide vital biological information for the neuropathological mechanism of cognitive impairment in this type of patients,which has important clinical guiding significance for early intervention therapy.