Kidney Week

Abstract: TH-OR126

Pediatric CKD Is Associated with Abnormal White Matter Integrity

Session Information

• Pediatric Nephrology Research
  November 07, 2019 | Location: 152, Walter E. Washington Convention Center
  Abstract Time: 06:06 PM - 06:18 PM

Category: Pediatric Nephrology

• 1700 Pediatric Nephrology

Authors

• Solomon, Matthew A., Stead Family Children's Hospital, Iowa City, Iowa, United States

Matthew A. Solomon, MD

• Koscik, Timothy R., University of Iowa, Iowa City, Iowa, United States

Timothy R. Koscik,

• Novak, Marci, University of Iowa, Iowa City, Iowa, United States

Marci Novak,

• Magnotta, Vincent, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States

Vincent Magnotta,

• Furth, Susan L., The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Susan L. Furth,

• Brophy, Patrick D., University of Rochester, Rochester, New York, United States

Patrick D. Brophy,

• Nopoulos, Peggy C., University of Iowa, Iowa City, Iowa, United States

Peggy C. Nopoulos,

• Harshman, Lyndsay, Stead Family Children's Hospital, Iowa City, Iowa, United States

Lyndsay Harshman,

Background

Children with chronic kidney disease (CKD) are at risk for neurocognitive deficits. Neuroimaging studies provide an opportunity to accurately assess the brain and yield clues to the underlying mechanisms of observed neurocognitive abnormalities. To date, few published studies exist evaluating brain structure in pediatric CKD and often involve heterogenous samples with late CKD/end-stage populations of varying etiologies.

Methods

We describe the effect of mild to moderate CKD on brain white matter integrity (WMI) using quantitative MRI diffusion tensor imaging. Patients age 6-16 with congenital, non-glomerular causes of CKD (eGFR 30-90 ml/min/1.73m2) were invited to participate [N_cases = 20, N_control = 26]. Participants completed a neurocognitive evaluation and MRI scan. WMI was calculated utilizing measurement of fractional anisotropy (FA). Voxel-wise linear regression models were calculated using R where FA values were predicted by CKD-status. Sex, age, blood pressure, and parental socioeconomic status were included as covariates.

Results

Relative to controls, CKD participants showed significant decreases in WMI within multiple brain regions including the right orbitofrontal cortex (Fig 1: t(54)=-3.74, p=0.000452, q=0.00722). Linear regression was performed to predict the relationship between regions with FA deficit and executive function. For males, lower FA within the right orbital frontal cortex was related to poorer executive function as measured by the Behavior Rating Inventory of Executive Function global executive composite (p = 0.006). In models adjusted for age, sex, participant type, and systolic blood pressure, lower FA within this region remained associated with poorer executive function (p = 0.011).

Conclusion

Our data demonstrate distinct white matter abnormalities in early pediatric CKD due to congenital anomalies of the kidney/urinary tract. Furthermore, these alterations in WMI are associated with executive function.

Figure 1: Localization of the right orbitofrontal WMI difference between cases (CKD) and controls (UC) [voxel coordinates xyz: 14.6, 46.8, -10.7].

Funding

• NIDDK Support