Purpose

To investigate cerebral blood flow (CBF) characteristics before and after hemodialysis initiation and their longitudinal associations with global cognitive function in older adults.

Methods

A cohort of 17 older end-stage renal disease patients anticipating standard thrice-weekly hemodialysis and a group of 11 age- and sex-matched healthy control volunteers were recruited for brain perfusion imaging studies using arterial spin labeling. Hemodialysis patients participated in a prospective longitudinal study using brain magnetic resonance imaging and global cognitive assessment using the Modified Mini-Mental State Examination (3MS) at two time points: baseline, 2.9 ± 0.9 months before, and follow-up, 6.4 ± 2.4 months after hemodialysis initiation. Healthy controls were imaged once using the same protocol. CBF analyses were performed globally in grey and white matter and regionally in the hippocampus and orbitofrontal cortex. Covariate-adjusted linear mixed-effects models were used for statistical analyses (significance: p < 0.05; marginal significance: p < 0.1).

Results

At baseline, global and regional CBF was significantly higher in hemodialysis patients than in healthy controls. However, after approximately 6 months of hemodialysis, CBF declined substantially in hemodialysis patients, and became comparable to those in healthy controls. Specifically, in the hemodialysis patients, CBF declined non-significantly globally for grey and white matter and significantly regionally in the hippocampus and orbitofrontal cortex. Marginally significant associations were observed between 3MS scores and regional CBF measurements in the hippocampus and orbitofrontal cortex at baseline and follow-up, and between longitudinal changes.

Conclusion

The significant decline in CBF after hemodialysis initiation and the observed association between longitudinal changes in regional CBF and 3MS scores suggest that decreased brain perfusion may contribute to the observed cognitive decline.

中文翻译：

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老年人血液透析开始后的脑血流特征：使用动脉自旋标记成像的前瞻性纵向试验研究

目的

研究老年人血液透析开始前后的脑血流 (CBF) 特征及其与整体认知功能的纵向关联。

方法

招募了一组 17 名预计每周进行三次标准血液透析的老年终末期肾病患者和一组 11 名年龄和性别匹配的健康对照志愿者，用于使用动脉自旋标记进行脑灌注成像研究。血液透析患者参与了一项前瞻性纵向研究，该研究使用脑磁共振成像和使用改良的简易精神状态检查 (3MS) 的全球认知评估在两个时间点：基线，2.9 ± 0.9 个月前，和随访，6.4 ± 2.4 个月血液透析开始后。使用相同的方案对健康对照成像一次。CBF 分析在灰质和白质中进行全球分析，并在海马和眶额皮质中进行局部分析。协变量调整的线性混合效应模型用于统计分析（显着性：p < 0.05；

结果

在基线时，血液透析患者的全球和区域 CBF 显着高于健康对照组。然而，经过大约 6 个月的血液透析，血液透析患者的 CBF 大幅下降，与健康对照者相当。具体来说，在血液透析患者中​​，CBF 在灰质和白质方面没有显着下降，而在海马和眶额皮质中则有显着的区域性下降。在基线和随访时，在 3MS 评分与海马和眶额皮质区域 CBF 测量值之间以及纵向变化之间观察到了轻微的显着关联。

结论

血液透析开始后 CBF 的显着下降以及观察到的区域 CBF 纵向变化与 3MS 评分之间的关​​联表明脑灌注减少可能导致观察到的认知能力下降。