Increased cerebral water content in hemodialysis patients

PLoS One. 2015 Mar 31;10(3):e0122188. doi: 10.1371/journal.pone.0122188. eCollection 2015.

Abstract

Little information is available on the impact of hemodialysis on cerebral water homeostasis and its distribution in chronic kidney disease. We used a neuropsychological test battery, structural magnetic resonance imaging (MRI) and a novel technique for quantitative measurement of localized water content using 3T MRI to investigate ten hemodialysis patients (HD) on a dialysis-free day and after hemodialysis (2.4±2.2 hours), and a matched healthy control group with the same time interval. Neuropsychological testing revealed mainly attentional and executive cognitive dysfunction in HD. Voxel-based-morphometry showed only marginal alterations in the right inferior medial temporal lobe white matter in HD compared to controls. Marked increases in global brain water content were found in the white matter, specifically in parietal areas, in HD patients compared to controls. Although the global water content in the gray matter did not differ between the two groups, regional increases of brain water content in particular in parieto-temporal gray matter areas were observed in HD patients. No relevant brain hydration changes were revealed before and after hemodialysis. Whereas longer duration of dialysis vintage was associated with increased water content in parieto-temporal-occipital regions, lower intradialytic weight changes were negatively correlated with brain water content in these areas in HD patients. Worse cognitive performance on an attention task correlated with increased hydration in frontal white matter. In conclusion, long-term HD is associated with altered brain tissue water homeostasis mainly in parietal white matter regions, whereas the attentional domain in the cognitive dysfunction profile in HD could be linked to increased frontal white matter water content.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Water*
  • Brain / metabolism*
  • Case-Control Studies
  • Humans
  • Kidney Failure, Chronic / metabolism
  • Kidney Failure, Chronic / therapy
  • Magnetic Resonance Imaging
  • Renal Dialysis*

Grants and funding

Sources of support: This work was supported in part by the Excellence Initiative of the German Research Foundation [DFG ZUK32/1] and the German Federal Ministry of Education and Research [BMBF 01GQ1402] to KR; and by a PhD fellowship (SFRH/BD/65743 2009) from the Fundação para a Ciência e Tecnologia (FCT), financed by the POPH – QREN Program to ASC. NJS and JBS were in part funded by the Helmholtz Alliance ICEMED - Imaging and Curing Environmental Metabolic Diseases [HA-314], through the Initiative and Network Fund of the Helmholtz Association. The sponsors had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. Bayer Pharma AG provided support for the authors TK and FE, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.