Kidney Week

Abstract: SA-PO0442

Cerebral Microvascular Integrity in Patients with CKD: A Comparative Study of Peak Width of Skeletonized Mean Diffusivity According to Dialysis Status

Session Information

• CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Park, Bongsoo, Inje University Haeundae Paik Hospital, Busan, Korea (the Republic of)

Bongsoo Park, MD

• Park, Sihyung, Inje University Haeundae Paik Hospital, Busan, Korea (the Republic of)

Sihyung Park, MD

Background

Cerebral small vessel disease (CSVD) is a potent risk factor for overt stroke and a primary cause of vascular dementia and cognitive impairment. Beyond being a localized brain lesion, CSVD serves as a systemic marker reflecting the overall integrity of the body's microvasculature. Peak width of skeletonized mean diffusivity (PSMD) is a novel diffusion tensor imaging (DTI) marker that captures diffuse white matter injury associated with CSVD. PSMD is considered a more accurate and sensitive predictor of damage than white matter hyperintensities (WMH), which represent chronic ischemic changes. Given the kidney-brain axis, this study aimed to compare PSMD values according to the severity of chronic kidney disease (CKD).

Methods

Brain DTI data from 38 dialysis-dependent CKD patients and 18 non-dialysis CKD patients were analyzed. PSMD values were calculated using an automated processing pipeline. Group differences were assessed using Welch's t-test. To identify independent predictors of PSMD, multivariable linear regression was performed, adjusting for laboratory data and Montreal Cognitive Assessment (MoCA) scores.

Results

Patients with dialysis-dependent CKD exhibited significantly higher PSMD values than patients with non-dialysis CKD (2.946±0.362 vs. 2.653±0.500 ×10^-4 mm²/s, p=0.035). The dialysis-dependent CKD group showed significant lower level of hemoglobin (11.8±1.8 vs 10.4±1.1 g/dL), albumin (4±0.3 vs 3.7±0.3 g/dL) and higher level of phosphorus (3.6±0.4 vs 4.5±0.9 mg/dL). There was no statistically significant difference in the MoCA scores (28.8±29.3 vs 22.6±5.3). PSMD had positive relationships with age (r=0.32), creatinine (r=0.41), BUN (r=0.32) and negative relationships with hemoglobin (r=-0.27). In a multiple linear regression model, creatinine was an independent predictor of PSMD level (β=0.34, p<0.05) after adjusting for age, hemoglobin, and BUN.

Conclusion

Dialysis patients show increased PSMD values compared to non-dialysis CKD patients, and creatinine levels are independently associated with this neuroimaging marker. Although creatinine levels in dialysis patients are highly dynamic, they serve as a comprehensive surrogate for the chronic uremic burden and systemic microvascular stress. These findings suggest that renal metabolic derangement, beyond traditional risk factors like age, significantly contributes to the progression of CSVD.

Acknowledgment

none.