Association between abnormal thalamic metabolites and sleep disturbance in patients with end-stage renal disease
- 57 Downloads
Sleep disturbances are common in end-stage renal disease (ESRD) patients. However, the underlying neuropathological mechanisms are largely unclear. Previous studies have revealed the important role of the thalamus in the potential mechanisms of sleep disorders. We hypothesized that the sleep disturbances in ESRD patients may correspond to metabolic changes of thalamus and the uremic factors may have a vital contribution on these changes. We performed multi-voxel 1H-MRS of bilateral thalami in 27 ESRD patients who currently receiving hemodialysis treatment and 21 age-matched healthy volunteers. ESRD patients underwent Pittsburgh Sleep Quality Index (PSQI) scale and restless legs syndrome (RLS) rating scale assessment. Laboratory blood tests including serum creatinine, serum urea, cystatin-C, serum parathyroid hormone (PTH), calcium and phosphorus levels, hemoglobin and hematocrit were performed in all ESRD patients close to the time of the MR examination. We found correlations among elevated PTH, higher PSQI score and RLS rating score in ESRD patients. ESRD patients displayed decreased N-acetylaspartate and creatine ratio (NAA/Cr) of thalami compared with controls. There were significantly negative correlation between NAA/Cr and serum PTH level or PSQI score. The metabolic changes of thalami played an important role in the neuropathological mechanisms of lower sleep quality in ESRD patients. Secondary hyperparathyroidism as one of the main uremia-related factors was closely related to abnormal metabolites of the thalamus in patients with ESRD, revealing the crosstalk procedure between renal impairment and brain function.
KeywordsEnd-stage renal disease Magnetic resonance spectroscopy Sleep quality Metabolites Thalamus
Ming Zhang and Ji-xin Liu were responsible for the design and study concept. Xue-ying Ma, Yan Zhang, Shao-hui Ma contributed to the data acquisition. Xue-ying Ma, Yan Zhang, Shaohui Ma, Peng Li and Dun Ding contributed to the data analysis and interpretation of findings. Xue-ying Ma drafted the manuscript. Ji-xin Liu and Ming Zhang revised the manuscript. Xue-ying Ma and Yan Zhang contributed equally to this work. All authors critically reviewed the manuscript and approved the final version for publication. This research was supported by the National Natural Science Foundation of China (Grant No. 81371530, 81571640 and 81471737) and Natural Science Foundation of Shaanxi Province of China (Grant No. 2017ZDJC-13).
This research was supported by the National Natural Science Foundation of China (Grant No. 81371530 and 81571640) and Natural Science Foundation of Shaanxi Province of China (Grant No. 2017ZDJC-13).
Compliance with ethical standards
Conflict of interest
The authors disclose no conflicts.
- Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, Zucconi M, Ferri R, Trenkwalder C, Lee HB (2014) Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated international restless legs syndrome study group (IRLSSG) consensus criteria – history, rationale, description, and significance. Sleep Med 15:860–873. https://doi.org/10.1016/j.sleep.2014.03.025 CrossRefGoogle Scholar
- Cortelli P, Perani D, Parchi P, Grassi F, Montagna P, De Martin M, Castellani R, Tinuper P, Gambetti P, Lugaresi E, Fazio F (1997) Cerebral metabolism in fatal familial insomnia: relation to duration, neuropathology, and distribution of protease-resistant prion protein. Neurology 49:126–133CrossRefGoogle Scholar
- Esposito MG, Cesare CM, De Santo RM, Cice G, Perna AF, Violetti E, Conzo G, Bilancio G, Celsi S, Annunziata F, Iannelli S, De Santo NG, Cirillo M, Livrea A (2008) Parathyroidectomy improves the quality of sleep in maintenance hemodialysis patients with severe hyperparathyroidism. J Nephrol 21 Suppl 13:S92–S96Google Scholar
- Ferrarelli F, Peterson MJ, Sarasso S, Riedner BA, Murphy MJ, Benca RM, Bria P, Kalin NH, Tononi G (2010) Thalamic dysfunction in schizophrenia suggested by whole-night deficits in slow and fast spindles. Am J Psychiatry 167:1339–1348. https://doi.org/10.1176/appi.ajp.2010.09121731 CrossRefPubMedPubMedCentralGoogle Scholar
- K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. (2002) Am J Kidney Dis 39:S1–266Google Scholar
- Ma X, Tian J, Wu Z, Zong X, Dong J, Zhan W, Xu Y, Li Z, Jiang G (2016) Spatial disassociation of disrupted functional connectivity for the default mode network in patients with end-stage renal disease. PLoS One 11:e0161392. https://doi.org/10.1371/journal.pone.0161392 CrossRefPubMedPubMedCentralGoogle Scholar
- Roman SA, Sosa JA, Pietrzak RH, Snyder PJ, Thomas DC, Udelsman R, Mayes L (2011) The effects of serum calcium and parathyroid hormone changes on psychological and cognitive function in patients undergoing parathyroidectomy for primary hyperparathyroidism. Ann Surg 253:131–137. https://doi.org/10.1097/SLA.0b013e3181f66720 CrossRefPubMedGoogle Scholar