Increased cerebral blood flow is correlated with neurocognitive impairment in long-term hemodialysis patients: an arteri
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ORIGINAL RESEARCH
Increased cerebral blood flow is correlated with neurocognitive impairment in long-term hemodialysis patients: an arterial spin labeling MRI study Chao Chai 1 & Mengjie Zhang 2 & Huiying Wang 1 & Jinping Li 3 & Tong Zhang 4 & Yingying Han 3 & Jinxia Zhu 5 & Xianchang Zhang 5 & Shuang Xia 1 & Wen Shen 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
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 MiniMental 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, longterm hemodialysis patients had increased CBF, which correlated with neurocognitive impairment, and after adjusting for the effect of anemia, the correlation still remained. Keywords Hemodialysis . Arterial spin labeling . Cerebral blood flow . Neurocognitive impairment . Hemoglobin
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11682-020-00377-5) contains supplementary material, which is available to authorized users. * Shuang Xia [email protected] * Wen Shen [email protected] 1
Department of Radiology, Tianjin First Central Hospital, Tianjin Medical Imaging Institute, Tianjin 300192, China
2
Department of Radiology, Tianjin Children’s Hospital, Tianjin, China
3
Department of Hemodialysis, Tianjin First Central Hospital, Tianjin, China
4
School of Graduates, Tianjin Medical University, Tianjin, China
5
MR Collaboration, Siemens Healthcare Ltd, Beijing, China
Abbreviations ESRD GFR CBF PET SPECT TCD CT ASL rHuEpo HCs PTH ALP SBP DBP PP MMSE
End-stage renal disease glomerular filtration rate cerebral blood flow positron emission tomography single-photon emission computed tomography transcranial Do
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