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Abstract: SA-PO404

Disruption of the Blood Brain Barrier in ESKD: A Novel Mechanism of Cognitive Impairment

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Gautam, Archana, The University of Kansas Medical Center, Kansas City, Kansas, United States
  • Lepping, Rebecca J., The University of Kansas Medical Center, Kansas City, Kansas, United States
  • Brooks, William M., The University of Kansas Medical Center, Kansas City, Kansas, United States
  • Young, Kate J., The University of Kansas Medical Center, Kansas City, Kansas, United States
  • Donald, Joseph, The University of Kansas Medical Center, Kansas City, Kansas, United States
  • Comfort, Branden W., The University of Kansas Medical Center, Kansas City, Kansas, United States
  • Faruque, Md Omar, The University of Kansas Medical Center, Kansas City, Kansas, United States
  • Montgomery, Neal, The University of Kansas Medical Center, Kansas City, Kansas, United States
  • Yu, Alan S.L., The University of Kansas Medical Center, Kansas City, Kansas, United States
  • Gupta, Aditi, The University of Kansas Medical Center, Kansas City, Kansas, United States
Background

Cognitive impairment is common in end stage kidney disease (ESKD). Although disruption of blood brain barrier (BBB) integrity is an early biomarker of cognitive impairment and dementia, BBB has not been assessed in ESKD since gadolinium-based contrast-enhanced MRI used to measure BBB is impractical in ESKD.

Methods

In this novel single-center cross-sectional pilot study, we used single-photon emission computed tomography (SPECT-CT) with 99mTc labelled DTPA to assess BBB integrity in ESKD. We enrolled 7 ESKD patients and 6 healthy controls (without chronic kidney disease). All participants underwent brain SPECT-CT and cognitive assessments. Cohens D was calculated to compare the SPECT-CT standardized uptake values (SUV) between ESKD and controls.

Results

Despite the ESKD group being younger (50.6 ± 13.3 years) than the control group (57.7 ± 5.9 years), the ESKD group had a higher SUV (0.241 ± 0.034) indicating a greater disruption of BBB integrity than the control group (0.161 ± 0.033), Cohens D (measure of standard deviations between two means) = 2.35. Figure 1 shows the distribution of SUVs. The ESKD group performed worse on neuropsychological tests, in particular tests of verbal fluency, delayed recall, and Trail making B, than the control group.

Conclusion

This is the first report demonstrating that BBB integrity is severely disrupted in ESKD patients compared with controls. The association of BBB disruption with cognitive impairment in ESKD suggests that BBB should be further studied as a novel mechanism underlying cognitive impairment in ESKD.

Funding

  • Other NIH Support