Elevated global cerebral blood flow, oxygen extraction fraction and unchanged metabolic rate of oxygen in young adults with end-stage renal disease: an MRI study
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To noninvasively assess global cerebral blood flow (CBF), oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) in young adults with end-stage renal disease (ESRD).
Thirty-six patients and 38 healthy volunteers were included and took part in MR examinations, blood and neuropsychological tests. CBF and OEF were measured by phase-contrast and T2-relaxation-under-spin-tagging MRI techniques, respectively. CMRO2 was computed from CBF, OEF and hematocrit according to Fick’s principle. Correlations were performed between MR measurements, blood biochemistry measurements and neuropsychological test scores.
Compared with controls, ESRD patients had elevated CBF (72.9 ± 12.5 vs. 63.8 ± 8.5 ml min−1 100 g−1, P < 0.001), elevated OEF (47.2 ± 10.2 vs. 35.8 ± 5.4 %, P < 0.001), but unaffected CMRO2 (199.5 ± 36.4 vs. 193.8 ± 28.6 μmol O2 min−1 100 g−1, P = 0.879). Hematocrit negatively correlated with CBF (r = −0.640, P < 0.001) and OEF (r = −0.701, P < 0.001), but not with CMRO2. Altered neuropsychological test scores of ESRD patients were associated with OEF and CBF, but not with CMRO2. There were weak relationships between eGFR and hematocrit (r = 0.308, P = 0.068) or CBF (r = 0.318, P = 0.059).
Our findings suggested that anaemic young adults with ESRD may afford higher CBF and OEF to maintain a normal CMRO2. Despite this compensatory process, however, cognitive function was still impaired and its severity was correlated with their CBF and OEF abnormality.
• Anaemic young adults with ESRD may afford higher CBF and OEF.
• Anaemic young adults with ESRD maintain a normal CMRO 2 .
• Cognitive function was still impaired in young ESRD adults.
• The severity of cognitive dysfunction correlated with CBF and OEF changes.
KeywordsEnd-stage renal disease Cerebral blood flow Oxygen extract fraction Cerebral metabolic rate of oxygen Uremic encephalopathy
Cerebral blood flow
Cerebral metabolic rate of oxygen
Digit symbol test
End-stage renal disease
Montreal cognitive assessment
Mini mental state examination
Number connection test type A
Self-rating anxiety scale
Self-rating depression scale
Oxygen extraction fraction
The scientific guarantor of this publication is Guang Ming Lu. This study has received funding by grants from National Natural Science Foundation of China (grant Nos. 81471644 and 81101039 to G.Z., grants Nos. 81322020, 81230032, and 81171313 to L.J.Z.), the Program for New Century Excellent Talents in the University (NCET-12-0260 to L.J.Z.), and the Special Grant from the China Postdoctoral Science Foundation (grant No. 2014 T71014 to G.Z.). No complex statistical methods were necessary for this paper.
Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology:prospective, observable study, performed at one centre.
- 3.United States Renal Data System (2014) 2014 annual data report: an overview of the epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, BethesdaGoogle Scholar
- 9.Papoiu AD, Emerson NM, Patel TS, Kraft RA, Valdes-Rodriguez R, Nattkemper LA, Coghill RC, Yosipovitch G (2014) Voxel-Based morphometry and arterial spin labeling fMRI reveal neuropathic and neuroplastic features of brain processing of itch in end-stage renal-disease. J Neurophysiol 112:1729–1738CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Zheng G, Wen J, Zhang L, Zhong J, Liang X, Ke W, Kong X, Zhao T, He Y, Zuo X, Luo S, Zhang LJ, Lu GM (2014) Altered brain functional connectivity in hemodialysis patients with end-stage renal disease: a resting-state functional MR imaging study. Metab Brain Dis 29:777–786CrossRefPubMedGoogle Scholar
- 20.Luo S, Qi RF, Wen JQ, Zhong JH, Kong X, Liang X, Xu Q, Zheng G, Zhang Z, Zhang LJ, Lu GM (2015) Abnormal intrinsic brain activity patterns in patients with end-stage renal disease undergoing peritoneal dialysis: A resting-state functional MR imaging study. Radiology 8:141913Google Scholar
- 24.Martin SZ, Madai VI, von Samson-Himmelstjerna FC, Mutke MA, Bauer M, Herzig CX, Hetzer S, Günther M5, Sobesky J (2015) 3D GRASE pulsed arterial spin labeling at multiple inflow times in patients with long arterial transit times: comparison with dynamic susceptibility-weighted contrast-enhanced MRI at 3 Tesla. J Cereb Blood Flow Metab 35:392–401CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002) Hepatic encephalopathy– definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 35:716–721CrossRefPubMedGoogle Scholar