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Kidney Week

Abstract: SA-PO550

Early Detection of White Matter Changes Through MRI Brain Diffusion Tensor Imaging (DTI) in ESRD Patients on Hemodialysis

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Dighe, Tushar Anil, Dr. D.Y. Patil Medical College, Pune, India
  • Saha, Debapriya, Dr. D.Y. Patil Medical College, Pune, India
  • Bale, Charan Bhadrappa, Dr. D.Y. Patil Medical College, Pune, India
  • Wakhare, Pavan, Dr. D.Y. Patil Medical College, Pune, India
  • Shinde, Nilesh, Dr. D.Y. Patil Medical College, Pune, India
  • Kulkarni, Akshay Rajiv, Dr. D.Y. Patil Medical College, Pune, India
  • Chavan, Abhijit Suresh, Dr. D.Y. Patil Medical College, Pune, India
  • Phadke, Chetan U., Dr. D.Y. Patil Medical College, Pune, India
  • Makan, Anuja Pradeep, Dr. D.Y. Patil Medical College, Pune, India
  • Godbole, Shreeharsh, Dr. D.Y. Patil Medical College, Pune, India
  • Sajgure, Atul, Dr. D.Y. Patil Medical College, Pune, India
Background

Neurological complications like stroke and cognition disorders contribute to morbidity and mortality in CKD patients significantly. It has been postulated that neurological adverse events and renal dysfunction in CKD patients are related at the pathogenesis level. Neurological changes in the brain in CKD patients can be detected by Magnetic resonance studies at a stage earlier than overt clinical symptom manifestation.

Methods

After obtaining approval from the Institutional Ethics Committee, 30 patients with end-stage renal disease on hemodialysis and 10 age-matched control persons without kidney disease underwent routine biochemical studies and an MRI brain on a 3T scanner. Fractional Anisotropy and Mean Diffusivity were calculated for corpus callosum genu and splenium, anterior and posterior corona radiata, pons, and cerebellar hemispheres on both sides. Conventional MRI images were evaluated for changes in small vessel disease. Student’s unpaired T-test was used to determine if the difference in results were statistically significant.

Results

18 out of 30 hemodialysis patients and three out of 10 control patients had white matter changes of small vessel disease detectable in conventional MRI sequences. Fractional anisotropy was significantly low for corpus callosum genu (p<0.003464 and p<0.007437,right and left sides respectively) and anterior corona radiata (p<0.04272 and p<.001653, right and left sides respectively) in hemodialysis patients than control. No significant difference in fractional anisotropy was noted for other locations. Mean diffusivity was higher at corpus callosum genu and anterior corona radiata in hemodialysis patients than in age-matched controls but did not reach statistical significance (p>0.05).

Conclusion

There are white matter changes detectable by DTI imaging in a quantitative manner in anterior corona radiata and corpus callosum genu in hemodialysis patients that is absent in age-matched control persons without renal disease. Further research is needed to use these early quantitative DTI changes to build robust predictive models for prognostication that will lead to comprehensive renal and neurological clinical management in CKD patients.