Correlation between brain imaging features and cognitive impairment in end-stage renal disease patients based on susceptibility-weighted imaging

doi:10.3969/j.issn.1674-8115.2025.06.011

Abstract

Abstract:

Objective ·To assess the number and distribution of cerebral microbleeds (CMBs) in patients with end-stage renal disease (ESRD) using susceptibility-weighted imaging (SWI), and to explore the relationship between SWI-detected imaging features and cognitive impairment. Methods ·Hospitalized ESRD patients who had received dialysis treatment for more than one year at Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, between January 2023 and March 2024 were included. All patients underwent conventional MRI sequences and SWI scanning. The number and regional distribution of CMBs were recorded. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Patients with MoCA scores ≥26 were classified into the ESRD without cognitive impairment group, and those with scores <26 were placed in the ESRD with cognitive impairment group. The presence and number of CMBs were analyzed in relation to cognitive impairment. The distribution of CMBs in various brain regions was examined, and correlations between the number of CMBs in specific regions and the severity of cognitive impairment were evaluated. Results ·A total of 38 patients were enrolled, including 16 in the ESRD with cognitive impairment group and 22 in the non-impaired group. CMBs were more frequently observed in the cognitively impaired group (14 cases, 87.50%) compared to the non-impaired group (12 cases, 54.55%), with a statistically significant difference (P=0.033). The impaired group had more CMBs (106 in total), primarily located in bilateral cortical and subcortical regions (59.43%) and the basal ganglia (19.81%). In contrast, the non-impaired group had fewer CMBs (47 in total), mainly located in the bilateral basal ganglia (46.80%) and cortical and subcortical regions (40.43%), with all regional distribution differences being statistically significant (both P<0.05). Among those with cognitive impairment, the number of CMBs in the cortical and subcortical areas was significantly negatively correlated with cognitive function (r=-0.718, P=0.030). Conclusion ·The number and distribution of CMBs detected by SWI in ESRD patients are associated with both the presence and severity of cognitive impairment. SWI can be used to identify CMBs formation and localization in ESRD patients, thereby aiding in the assessment of cognitive dysfunction.

Key words: end-stage renal disease (ESRD), cerebral microbleed (CMB), cognitive impairment, susceptibility-weighted imaging (SWI)

CLC Number:

R445.2

GU Liangrui, YAN Bicong, FANG Tonglei, WU Jinliang. Correlation between brain imaging features and cognitive impairment in end-stage renal disease patients based on susceptibility-weighted imaging[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(6): 760-765.

Figures/Tables 4

TrendMD

References 20

[1]	INKER L A, ASTOR B C, FOX C H, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD[J]. Am J Kidney Dis, 2014, 63(5): 713-735.
[2]	JHA V, GARCIA-GARCIA G, ISEKI K, et al. Chronic kidney disease: global dimension and perspectives[J]. Lancet, 2013, 382(9888): 260-272.
[3]	LI P, MA S H, MA X Y, et al. Reversal of neurovascular decoupling and cognitive impairment in patients with end-stage renal disease during a hemodialysis session: evidence from a comprehensive fMRI analysis[J]. Hum Brain Mapp, 2023, 44(3): 989-1001.
[4]	Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease[J]. Kidney Int Suppl, 2013, 3(1): 1-150.
[5]	NASREDDINE Z S, PHILLIPS N A, BÉDIRIAN V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment[J]. J Am Geriatr Soc, 2005, 53(4): 695-699.
[6]	SUN W, LI C, JIAO Z Q, et al. Multiparameter neuroimaging study of neurovascular coupling changes in patients with end-stage renal disease[J]. Brain Behav, 2024, 14(6): e3598.
[7]	LI A M, MU J Y, HUANG M X, et al. Altered amygdala-related structural covariance and resting-state functional connectivity in end-stage renal disease patients[J]. Metab Brain Dis, 2018, 33(5): 1471-1481.
[8]	GORELICK P B, SCUTERI A, BLACK S E, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2011, 42(9): 2672-2713.
[9]	谢青, 敬丽, 伍建林. 终末期肾病患者认知功能损伤的静息态功能MRI研究进展[J]. 中国医学影像技术, 2018, 34(3): 448-451.
	XIE Q, JING L, WU J L. Research progress of resting-state functional MRI in patients of end-stage renal disease with cognitive impairment[J]. Chinese Journal of Medical Imaging Technology, 2018, 34(3): 448-451.
[10]	GYANWALI B, LUI B, TAN C S, et al. Cerebral microbleeds and white matter hyperintensities are associated with cognitive decline in an Asian memory clinic study[J]. Curr Alzheimer Res, 2021, 18(5): 399-413.
[11]	CHENG A L, BATOOL S, MCCREARY C R, et al. Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds[J]. Stroke, 2013, 44(10): 2782-2786.
[12]	LI P, DING D, MA X Y, et al. Altered intrinsic brain activity and memory performance improvement in patients with end-stage renal disease during a single dialysis session[J]. Brain Imag Behav, 2018, 12(6): 1640-1649.
[13]	CHEN P N, HU R Y, GAO L, et al. Abnormal degree centrality in end-stage renal disease (ESRD) patients with cognitive impairment: a resting-state functional MRI study[J]. Brain Imaging Behav, 2021, 15(3): 1170-1180.
[14]	WERRING D J, FRAZER D W, COWARD L J, et al. Cognitive dysfunction in patients with cerebral microbleeds on T2*-weighted gradient-echo MRI[J]. Brain, 2004, 127(Pt 10): 2265-2275.
[15]	JANSEN J, JANSEN K, NEVEN E, et al. Remote sensing and signaling in kidney proximal tubules stimulates gut microbiome-derived organic anion secretion[J]. Proc Natl Acad Sci USA, 2019, 116(32): 16105-16110.
[16]	BABIKIAN T, FREIER M C, TONG K A, et al. Susceptibility weighted imaging: neuropsychologic outcome and pediatric head injury[J]. Pediatr Neurol, 2005, 33(3): 184-194.
[17]	DIERKSEN G A, SKEHAN M E, KHAN M A, et al. Spatial relation between microbleeds and amyloid deposits in amyloid angiopathy[J]. Ann Neurol, 2010, 68(4): 545-548.
[18]	SONG W J, ZHAO L Y, LI X K, et al. Altered brain activity in patients with end-stage renal disease: a meta-analysis of resting-state functional imaging[J]. Brain Behav, 2023, 13(7): e3057.
[19]	DING D, LI P, MA X Y, et al. The relationship between putamen-SMA functional connectivity and sensorimotor abnormality in ESRD patients[J]. Brain Imaging Behav, 2018, 12(5): 1346-1354.
[20]	CHANDRAN M, YEH L T L, DE JONG M C, et al. Cognitive deficits in primary hyperparathyroidism: what we know and what we do not know: a narrative review[J]. Rev Endocr Metab Disord, 2022, 23(5): 1079-1087.

Characteristic	ESRD with cognitive impairment (n=16)	ESRD without cognitive impairment (n=22)	t/χ²value	P value
Age/year	37.2±7.3	38.8±7.5	1.313	0.242
Gender/n			0.210	0.743
Male	9	14
Female	7	8
Duration of education/year	11.32±2.61	11.88±2.25	-0.219	0.844
Systolic pressure^①/mmHg	152.40±19.61	147.58±13.22	1.840	0.069
Duration of recent dialysis/d	2.6±0.9	2.1±1.3	0.359	0.731

Characteristic	ESRD with cognitive impairment (n=16)	ESRD without cognitive impairment (n=22)	t/χ²value	P value
Age/year	37.2±7.3	38.8±7.5	1.313	0.242
Gender/n			0.210	0.743
Male	9	14
Female	7	8
Duration of education/year	11.32±2.61	11.88±2.25	-0.219	0.844
Systolic pressure^①/mmHg	152.40±19.61	147.58±13.22	1.840	0.069
Duration of recent dialysis/d	2.6±0.9	2.1±1.3	0.359	0.731

Brain region	CMB in ESRD group with cognitive impairment (n=106)	CMB in ESRD group without cognitive impairment (n=47)	χ²	P value
Cortex and subcortical area/n(%)	63 (59.43)	19 (40.43)	4.74	0.029
Basal ganglion/n(%)	21 (19.81)	22 (46.80)	11.25	0.001
Brainstem/n(%)	7 (6.60)	2 (4.26)	‒	0.440
Cerebellum/n(%)	15 (14.15)	4 (8.51)	‒	0.244

Brain region	CMB in ESRD group with cognitive impairment (n=106)	CMB in ESRD group without cognitive impairment (n=47)	χ²	P value
Cortex and subcortical area/n(%)	63 (59.43)	19 (40.43)	4.74	0.029
Basal ganglion/n(%)	21 (19.81)	22 (46.80)	11.25	0.001
Brainstem/n(%)	7 (6.60)	2 (4.26)	‒	0.440
Cerebellum/n(%)	15 (14.15)	4 (8.51)	‒	0.244