Cerebral microangiopathy according to magnetic resonance imaging of the brain in patients undergoing longterm programmed hemodialysis

Author:

Khrulev A. E.1ORCID,Shiyanova N. A.1ORCID,Grigorieva V. N.1ORCID,Vlasov G. N.2ORCID,Kоzulina L. S.2ORCID,Egorskaya A. T.1ORCID

Affiliation:

1. Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation

2. Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko

Abstract

Introduction. Cerebral microangiopathy (CMA), being the leading cause of vascular cognitive impairment and strokes, has a number of causes, among which chronic kidney disease (CKD) and programmed hemodialysis (HD) are the least studied.Purpose of the study: to determine the frequency of CMA neuroimaging markers and risk factors for its development in patients receiving renal replacement therapy for a long time using the programmed HD.Material and methods: the study involved 70 patients who had been on programmed HD for 10 months or more. Clinical neurological examination, laboratory tests and brain MRI were performed. The analysis of CMA neuroimaging markers was carried out in accordance with the STRIVE recommendations. Cerebral Small Vessel Disease Score (CSVDS) was used to quantify the overall severity of MR imaging markers of CMA.Results. Among 70 examined (29 men and 41 women) aged 53.0 ± 14.2 years, average HD experience – 70.0 ± 39.5 months, the main clinical manifestations of CMA were cognitive impairment (82.9%, n = 58), emotional disorders (61.4%, n = 43), sleep disorders (38.6%, n = 27), pseudobulbar syndrome (17.1%, n = 12), walking disorders (8.6%, n = 6), acute lacunar syndromes (7.1%, n = 5) and pelvic dysfunction (4.3%, n = 3). CMA neuroimaging markers of varying severity were found in 100% of cases. Expansion of perivascular spaces (100%, n = 70) and white matter hyperintensities (81.4%, n = 57) prevailed in the structure of CMA imaging markers. Cortical atrophy (67%, n = 47), cerebral microbleeds (47%, n = 33), asymptomatic lacunae (35.7%, n = 25) and minor subcortical infarctions (2.9%, n = 3) were less common. Mild CMA (1–2 points on the CSVDS scale) was determined in 38 patients (54.3%), severe CMA (3–4 points on the CSVDS scale) – in 32 patients (45.7%). The presence of uncontrolled arterial hypertension (OR 1.85, p < 0.05), intradialysis hypertension (OR 2.8, p < 0.05), dialysis vegetative polyneuropathies (OR 2.75, p < 0.05), type 2 diabetes mellitus (OR 5.7, p < 0.05) and the experience of programmed HD (more than 50 months) (OR 3.1, p < 0.05) were prognostic signifi cance for the development of severe CMA in dialysis patients.Conclusion. All patients with end-stage CKD who have been on programmed HD for a long time are shown to undergo the brain MRI in order to timely diagnose CMA imaging markers and possible correction of therapy.

Publisher

Medical Informational Agency Publishers

Subject

Psychiatry and Mental health,Neurology (clinical),Neurology

Reference21 articles.

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3. Khrulev A.E., Nikitina A.A., Khruleva N.S. Specific risk factors for cerebrovascular disorders in patients with chronic kidney disease in the pre-dialysis period. Cardiovascular therapy and prevention (Kardiovaskulyarnaya terapiya i profilaktika). 2019;18(3):88–93. (In Russian)]. https://doi.org/10.15829/1728-8800-2019-3-88-93

4. Andrusev A.M., Tomilina N.A., Peregudova N.G., Shinkarev M.B. Renal replacement therapy for end stage renal disease in Russian federation, 2014-2018. Russian national renal replacement therapy registry report of Russian national public organization of nephrologists Russian dialysis society. Nephrology and dialysis (Nefrologiya i dializ). 2020;22(1):1–71. (In Russian) https://doi.org/10.28996/2618-9801-2020-1suppl-1-71

5. Wardlaw J.M., Smith E.E., Biessels G.J., Cordonnier C., Fazekas F., Frayne R. et al.; STandards for ReportIng Vascular changes on nEuroimaging (STRIVE v1). Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurology. 2013;12(8):822–838. https://doi.org/10.1016/S1474-4422(13)70124-8

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