Changes Of Brain Structure And Cognitive Function In End-stage Renal Disease Patients Undergoing Maintenance Hemodialysis:A Clinical Voxel-based Diffusion Kurtosis Imaging Study

Objective:The aim of this study is to to explore the microstructural changes in the brain of patients with end stage renal disease(ESRD)who received regular hemodialysis for a long time by using diffusion kurtosis imaging(DKI) based on the method of voxel-based analysis(VBA),and analyze the correlations between the DKI evaluation Indicators and neuropsychological evaluation results to explore the objective imaging markers of cognitive impairment in patients with end stage renal disease(ESRD).Methods:Twenty-eight patients(13 male and 15 female)with ESRD patients who received maintaining hemodialysis treatment in the hemodialysis center of Nephrology Department of Affiliated Changzhou No.2 hospital of Nanjing Medical University of from January 2020 to October 2020 were recruited as patient group,and twenty-six(10 male and 16 female)age,sex and education matched healthy controls were enrolled.Montreal cognitive assessment(Mo CA),trail marking test and MR were performed by a trained doctor.The overall cognitive function was evaluated by Mo CA.Kurtosis(MK),axial kurtosis(AK)and radial kurtosis(RK)were obtained by DKE software.Independent sample t test based on SPM12 software was performed to evaluate the significant difference of DKI parameters of two groups.The measurement data(age,years of education,duration of dialysis,neurological scale score)were analyzed by SPSS25.0 software.Finally the correlation between DKI parameter values and neuropsychological scale tests were examined.Results:1.Comparison of clinical data:there was no significant difference in the demographic datas(age,sex and education)between the two groups(P >0.05).There was significant difference in neuropsychological assessment scale score between the two groups.The scores of Mo CA in the ESRD group were lower than those in the healthy control group(P<0.05).The scores of TMT-A and TMT-B in the ESRD group were higher than those in the healthy control group(P<0.05).2.Comparison of DKI parameters between the two groups:there was significant difference in the MK,AK value between the ESRD group and the healthy control group(P<0.05).there was no significant difference in the RK value between the ESRD group and the healthy control group(P>0.05).The results of this study showed a significant decrease in the MK values of right frontal lobe Sub-Gyral(26voxels,t=5.87),the AK values of anterior part of cingulate gyrus(55voxels,t=7.08),right insular lobe(29 voxels,t=6.18),right postcentral gyrus(51 voxels,t=6.45)and right supramarginal gyrus(30 voxels,t=6.4)compared with normal subjects(P<0.05).3.Analysis of the correlation between the DKI parameters of brain region and the score of Neuropsychological scale:bivariate correlation analysis suggested that MK values in right frontal lobe Sub-Gyral and AK values of anterior cingulate gyrus and right insular lobe were positively correlated with Mo CA scores.bivariate correlation analysis suggested that MK values in right frontal lobe Sub-Gyral and AK values of anterior cingulate gyrus and right insular lobe were negatively correlated with TMT-A and TMT-B scores.Conclusion:MK,AK values may be used as an imaging markers of cognitive impairment for ESRD patients.