Brain White Matter Changes And Correlations With Cognition In End-stage Renal Disease Patients With Secondary Hyperparathyroidism Based On Local Diffusion Homogeneity Values

Background End-stage renal disease refers to chronic kidney disease with glomerular filtration rate(GFR)<15 m L/(min/1.73m3)or requiring permanent renal replacement therapy(e.g.maintenance hemodialysis and peritoneal dialysis)at the end stage.Endstage renal disease can cause secondary hyperparathyroidism(SHPT)to cause elevated parathyroid hormone(PTH)in the body,and it has been reported in the literature that elevated parathyroid hormone may be associated with cognitive function: PTH can cross Blood-brain barrier directly affects brain tissue,or affects cognition by indirectly causing calcium and phosphorus metabolic disorders and local cerebral blood flow.Therefore,secondary hyperparathyroidism in end-stage renal disease significantly increases the risk of developing cognitive impairment in patients.however,current research on cognition and brain white matter structural change in patients with secondary hyperparathyroidism in end-stage renal disease remains lacking.GONG et al.proposed a new measure—Local Diffusion Homogeneity(LDH)to reveal more complete facial white matter changes;LDH is a model-free dispersion coefficient index calculated from the original diffusionweighted imaging(DWI)for measuring the voxel similarity of the full diffusion profiles between several closely positioned voxels.A new DTI parameter—LDH,combined with the Montreal Cognitive Assessment(Mo CA)scores and related clinical parameters,was used to investigate the recognition of patients with secondary hyperparathyroidism’ Knowledge and white matter changes provide imaging evidence for intact parathyroid hormone(i PTH)in terms of cognitive function and effects of white matter structure,with a view to providing clinical assistance in understanding the mechanism and treatment of neurological impairment in patients with secondary hyperparathyroidism.Objective To investigate the changes of white matter in patients of end-stage renal disease(ESRD)with secondary hyperparathyroidism(SHPT)by using local diffusion homogeneity(LDH).Methods Fifty patients diagnosed as ESRD and underwent hemodialysis were selected.According to whether with SHPT or not,the patients were divided into SHPT group(n=25)and non-SHPT group(n=25).The cognitive function was evaluated with Montreal Cognitive Assessment(Mo CA).Then MR plain scan was performed.The LDH value of white matter fiber in the whole brain were compared between 2groups based on voxel.Results Analysis by TBSS method showed that:Compared with non-SHPT group,SHPT group showed diffuse and symmetrical LDH decreased area in bilateral cerebral hemispheres,and in the focal right cerebellar hemispheres(all P<0.01).The areas with increased LDH value were mainly in brainstem and cerebellum(P<0.01).Clinical data shows that:In SHPT group,the total score of Mo CA was negatively correlated with the level of i PTH(r=-0.525),positively correlated with the level of education(r=0.413),the total score of Mo CA was positively correlated with the LDH value of left corticospinal tract(r=0.500),(all P<0.05),while the level of i PTH was not correlated with the LDH value of different brain regions(all P>0.05).Conclusion LDH value can provide information of the white matter’s LDH in ESRD patients with SHPT,and this change are related to cognition and clinical indicators.