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Abstract: SA-PO666

Peritoneal Dialysis Patients Exhibit Quantifiable Neurocognitive Impairment but Not Acute Ischemic Brain Injury: A Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging Study

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Vanderlinden, Jessica, Western University Department of Medical Biophysics, London, Ontario, Canada
  • Wong, Dickson Yi On, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
  • Chiu, Michael, Lawson Health Research Institute, London, Ontario, Canada
  • McIntyre, Christopher W., Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
  • Jain, Arsh, Lawson Health Research Institute, London, Ontario, Canada
Background

Patients receiving hemodialysis (HD) are known to suffer recurrent ischemic multiorgan injury, which effects the vulnerable vascular beds of the brain. These acute cerebral insults are associated with significant white matter (WM) injury, ultimately leading to neurocognitive impairment. PD patients are not subject to the equivalent circulatory stress as HD patients suggesting PD is relatively neuro-protective. Our objective was to utilize an imaging-based approach previously applied to a HD cohort to examine the acute intradialytic effects of PD.

Methods

Patients completed a neurocognitive battery (The Montreal Cognitive Assessment (MoCA), Trails Making Test (TMT), and Cambridge Brain Science (CBS)), an intradialytic MRI scan encompassing diffusion tensor imaging (DTI, WM integrity), and a proton magnetic resonance spectroscopy (1H-MRS, neurochemistry). Imaging and neurocognitive assessments were performed before PD exchange, with repeat imaging after 90 minutes of dwell time.

Results

12 patients receiving PD were studied. Patient demographics included (mean±SD): 67±8 years of age, 75% male, 75% diabetic, dialysis vintage 18±10 months, ultrafiltration 0.58±0.36L, and PD exchange 8.3% with 2.5% and 91.7% with 4.25% dextrose. Neurocognitive impairment (%impaired) was evident by the TMTA/B measuring attention (A=92%) and executive function (B=42%). CBS tasks are classified by their contribution to verbal, short-term memory, and reasoning domains. The verbal weighted domain component score demonstrated the most impairment (46%). Finally, 2/12 patients (17%) exhibited global impairment detected by the MoCA. DTI imaging demonstrated no acute effects on WM integrity. However, 1H-MRS detected a 21% increase in brain glucose concentration (p=0.006).

Conclusion

PD patients exhibited quantifiable neurocognitive deficits, but did not suffer acute intradialytic WM injury, supporting that PD may have neuro-protective benefits. PD dwell did result in brain hyperglycemia, indicative of acute metabolic stress. This may translate into an alternative hypothesis for progressive neurocognitive impairment via advanced glycation end-products, but further research is necessary.

Funding

  • Private Foundation Support