Glymphatic system dysfunction in nondialysis-dependent ESRD patients with diabetic kidney disease: associations with clinical characteristics and cognitive function

Ren Fail. 2024 Dec;46(2):2425160. doi: 10.1080/0886022X.2024.2425160. Epub 2024 Nov 7.

Abstract

Objectives: To investigate glymphatic function in nondialysis-dependent ESRD (ND-ESRD) patients with diabetic kidney disease (DKD) or non-DKD using the diffusion tensor image analysis along the perivascular space (DTI-ALPS) method and choroid plexus (CP) volume to explore the associations among DTI-ALPS index, CP volume, clinical characteristics, and cognitive function.

Methods: 25 DKD patients, 25 non-DKD patients, and 25 healthy control (HC) were included in this study. All participants underwent cerebral MRI and cognitive assessments. Bilateral DTI-ALPS index and CP volume were calculated and were compared among three groups. Correlations among the DTI-ALPS index, CP volume, clinical characteristics, and cognitive function were analyzed.

Results: DKD patients had significantly lower left DTI-ALPS index (p = 0.001) and mean DTI-ALPS index (p = 0.003) than non-DKD patients. In ND-ESRD patients, there was a significant positive correlation between the left DTI-ALPS index and phosphorus (r = 0.377, p = 0.007) and attention score (r = 0.434, p = 0.002). In DKD group, the mean DTI-ALPS was positively correlated with total cholesterol (r = 0.631, p = 0.001). In non-DKD group, there was a significant positive correlation between the left DTI-ALPS index and phosphorus (r = 0.696, p < 0.001). Both DKD and non-DKD patients exhibited significant higher CP volume than HC group. In non-DKD group, CP volume was negatively correlated with mean DTI-ALPS (r = -0.535, p = 0.006) and attention score of MoCA (r = -0.538, p = 0.006).

Conclusions: Glymphatic system dysfunction may contribute to the pathogenesis of clinical and cognitive impairment in ND-ESRD patients especially with DKD.

Keywords: End-stage renal disease; choroid plexus volume; cognitive impairment; diabetic kidney disease; diffusion tensor imaging-perivascular space index; nondialysis-dependent.

MeSH terms

  • Adult
  • Aged
  • Case-Control Studies
  • Cognition*
  • Cognitive Dysfunction / etiology
  • Cross-Sectional Studies
  • Diabetic Nephropathies* / complications
  • Diabetic Nephropathies* / physiopathology
  • Diffusion Tensor Imaging*
  • Female
  • Glymphatic System* / diagnostic imaging
  • Glymphatic System* / physiopathology
  • Humans
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / physiopathology
  • Male
  • Middle Aged

Grants and funding

This work was supported by the National Outstanding Youth Science Fund Project of National Natural Science Foundation of China (82202099, 52227814), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (contract grant numbers: ZYLX201824 and ZYLX202101), Beijing Municipal Administration of Hospital’s Mission Plan (contract grant number: SML20150101), Beijing Scholar 2015 (Zhenchang Wang), Beijing Friendship Hospital, Capital Medical University (contract grant number: seed project YYZZ202129, yyqcjh2023-7), and Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University (CCMU2022ZKYXY011).