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Abstract: SA-PO549

Cerebrovascular Function and Brain Structure in Hemodialysis Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Wolfgram, Dawn F., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Schmit, Brian, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Richerson, Wesley, Vanderbilt University, Nashville, Tennessee, United States
Background

Hemodialysis (HD) patients often have decline in cerebral blood flow (CBF) and cerebral oxygen saturation during HD. Cerebrovascular reactivity (CVR) measured at rest may be able to identify individuals susceptible to intradialytic hypoperfusion and ischemic brain injury. We hypothesized that HD patients would have decreased CVR and increased CBF relative to controls and that decreased CVR would be related to structural brain lesions.

Methods

In 10 HD patients and 10 controls, we measured cortical thickness and white matter hyperintensity (WMH) volume from the T1 and T2 FLAIR respectively, CVR from a breath hold during BOLD CVR fMRI, and arterial transit time and CBF from arterial spin labelling. Differences in these measures between the groups were tested by averaging across the tissue and with a pothole analysis. We correlated cortical thickness and WMH volume with cerebrovascular variables to assess the relationship between brain structure and cerebrovascular health in HD patients.

Results

Compared to controls, the HD cohort had decreased cortical thickness, increased WMH volume (p=0.002, p=0.004), and increased white matter CBF (p=0.02). Pothole analysis demonstrated a greater number of increased gray and white matter CBF voxels (p=0.03, p=0.02) and a greater number of decreased gray and white matter CVR voxels (p=0.02, p=0.01). No significant relationships were found between cortical thickness or WMH volume and CVR or CBF.

Conclusion

HD patients have structural injury with decreased cortical thickness and increased WMH. Notably, HD patients had increased CBF and decreased CVR. However, we did not find that decreased CVR correlated with decreased cortical thickness or increased WHM in this pilot study.

Pothole count of higher CBF and lower CVR. Brighter yellow indictes a greater prevalence of potholes in that location

Funding

  • NIDDK Support