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Increased cerebral blood flow is correlated with neurocognitive impairment in long-term hemodialysis patients: an arterial spin labeling MRI study

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Abstract

The purpose of this study was to investigate cerebral blood flow (CBF) changes in hemodialysis patients with arterial spin labeling (ASL) and to correlate these changes with clinical risk factors and neurocognitive function. Thirty-two hemodialysis patients and 35 age-, sex-, and education-matched healthy controls (HCs) were recruited in this prospective study. The Mini-Mental State Examination (MMSE) was performed to evaluate neurocognitive function. Pulsed ASL was performed to measure CBF. Two independent sample t-test was used to explore the CBF difference between the patients and HCs. Multiple stepwise regression was used to investigate the risk factors for CBF in patients. Correlation analysis was used to explore the relationship between the MMSE scores and CBF changes with and without adjusting for anemia status. Compared to HCs, the hemodialysis patients showed significantly increased CBF in some neurocognition-related cerebral regions (all P < 0.001, Bonferroni corrected). Increased CBF in the right opercular and triangular part of the inferior frontal gyrus correlated with the poorer MMSE scores (r = -0.502, P = 0.004; r = -0.423, P = 0.018, FDR corrected) and these correlations still remained after adjusting for anemia status (r = -0.516, P = 0.005; r = -0.439, P = 0.019, FDR corrected). The increased dialysis duration, and decreased hemoglobin, hematocrit, and serum phosphorus were predictive risk factors for increased CBF (P < 0.05). In conclusion, long-term hemodialysis patients had increased CBF, which correlated with neurocognitive impairment, and after adjusting for the effect of anemia, the correlation still remained.

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Abbreviations

ESRD:

End-stage renal disease

GFR:

glomerular filtration rate

CBF:

cerebral blood flow

PET:

positron emission tomography

SPECT:

single-photon emission computed tomography

TCD:

transcranial Doppler ultrasonography

CT:

computed tomography

ASL:

arterial spin labeling

rHuEpo:

recombinant human erythropoietin

HCs:

healthy controls

PTH:

parathyroid hormone

ALP:

alkaline phosphatase

SBP:

systolic blood pressure

DBP:

diastolic blood pressure

PP:

pulse pressure

MMSE:

Mini-Mental State Examination

AC-PC:

anterior-posterior commissural

T1-MPRAGE:

T1-weighted magnetization-prepared rapid acquisition gradient echo

FWHM:

a full width at half-maximum

MNI:

Montreal Neurological Institute

VIF:

variance inflation factor

FDR:

false discovery rate

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Acknowledgements

This work was supported by the Natural Scientific Foundation of China (Grant No. 81901728 to Chao Chai, No. 81871342 to Shuang Xia, and No. 81873888 to Wen Shen) and National Key Technologies Research and Development Program of China (Grant No. 2019YFC0120901 to Shuang Xia).

The authors would like to thank Gang Zheng and TianYi Qian for the analysis of the data, and Prof. E Mark Haacke, from Department of Radilogy, Wayne State University for the editing of the paper.

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Authors and Affiliations

  1. Department of Radiology, Tianjin First Central Hospital, Tianjin Medical Imaging Institute, Tianjin, 300192, China

    Chao Chai, Huiying Wang, Shuang Xia & Wen Shen

  2. Department of Radiology, Tianjin Children’s Hospital, Tianjin, China

    Mengjie Zhang

  3. Department of Hemodialysis, Tianjin First Central Hospital, Tianjin, China

    Jinping Li & Yingying Han

  4. School of Graduates, Tianjin Medical University, Tianjin, China

    Tong Zhang

  5. MR Collaboration, Siemens Healthcare Ltd, Beijing, China

    Jinxia Zhu & Xianchang Zhang

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  1. Chao Chai
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Supplementary Fig. 1

There are no significant correlations between CBF of the bilateral hippocampus and the MMSE scores before adjusting for hemoglobin and hematocrit levels (left: r = -0.195, P = 0.284; right: r = -0.136, P = 0.458, FDR corrected). (PNG 4331 kb)

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Chai, C., Zhang, M., Wang, H. et al. Increased cerebral blood flow is correlated with neurocognitive impairment in long-term hemodialysis patients: an arterial spin labeling MRI study. Brain Imaging and Behavior 15, 1828–1839 (2021). https://doi.org/10.1007/s11682-020-00377-5

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