Kidney Week

Abstract: TH-OR12

Application of Intradialytic Magnetic Resonance Imaging and Spectroscopy Demonstrates Hemodialysis-Related Acute Brain Injury

Session Information

• Dialysis: Patient-Centered Interventions and Outcomes
  November 03, 2022 | Location: W414, Orange County Convention Center‚ West Building
  Abstract Time: 04:39 PM - 04:48 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Wong, Dickson Yi On, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada

Dickson Yi On Wong, MD, PhD

• Anazodo, Udunna C., Lawson Health Research Institute, London, Ontario, Canada

Udunna C. Anazodo,

• Théberge, Jean, Lawson Health Research Institute, London, Ontario, Canada

Jean Théberge,

• Dacey, Madeleine Therese, Western University Department of Medical Biophysics, London, Ontario, Canada

Madeleine Therese Dacey,

• Gomes, Janice, Western University Department of Pathology and Laboratory Medicine, London, Ontario, Canada

Janice Gomes,

• Penny, Jarrin D., Western University Department of Medical Biophysics, London, Ontario, Canada

Jarrin D. Penny,

• Van Ginkel, Michael J., Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada

Michael J. Van Ginkel,

• Poirier, Stefan E., Western University Department of Medical Biophysics, London, Ontario, Canada

Stefan E. Poirier,

• McIntyre, Christopher W., Lawson Health Research Institute, London, Ontario, Canada

Christopher W. McIntyre,

Background

Hemodialysis (HD) provides lifesaving treatment for patients with end stage kidney disease. However, treatment related hemodynamic stress results in recurrent ischemic injury to vulnerable organs, such as the heart. Short term reduction in brain blood flow and long-term white matter (WM) changes have been reported. However, the basis of HD-induced brain injury is neither well recognized nor understood even though progressive cognitive impairment is common.

Methods

21 patients (age: 63±13 years, male: 58.8%) were recruited. Study procedures included neurocognitive assessments, intradialytic anatomical magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (¹H-MRS). Data acquired before HD and during the last 60 minutes of HD (during peak hemodynamic stress) were analyzed to assess the acute impact of HD on the brain.

Results

HD resulted in the development of multiple regions of white matter (WM) intradialytic fractional anisotropy (FA) increase with associated mean diffusivity (MD) and radial diffusivity (RD) decreases (Fig. 1a), characteristic features of cytotoxic edema (with increase in global brain volumes, Fig. 1b). Decreases in ¹H-MRS measured NAA and choline concentrations during HD were also observed (Fig. 2), indicative of regional ischemia. Severity of WM changes were associated with reduced cognitive function performance, particularly relating to executive functioning (Fig. 1c).

Conclusion

This study demonstrates, for the first time, that functionally significant intradialytic changes in brain tissue volume, diffusion metrics, and brain metabolite concentrations consistent with ischemic injury occurs. Preventing HD-induced brain injury requires urgent additional investigation to improve subjective tolerability of treatment and maintenance of independence and cognitive vitality for patients.

Funding

• Private Foundation Support