Frontiers in medicine · 2026
Structural brain changes, cerebral oxygenation, and cognitive function in hemodialysis patients: a cross-sectional study.
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Michna Martin, Burgetova Romana, Kremenova Karin, Burgetova Andrea, Krasensky Jan, Lukavsky Jiri, Szonowska Barbora, Rychlik Ivan, Malikova Hana, Malik Jan
Аннотация
BACKGROUND: Cognitive impairment is frequent in end-stage kidney disease (ESKD) patients, who also have brain structural changes and reduced regional cerebral oxygenation (rSO2). However, the relationship between these parameters remains insufficiently explored. The primary aim of this study was to compare cognition, brain structural changes and cerebral oxygenation between hemodialysis (HD) patients and healthy controls. The secondary aim was to assess the relationship between cerebral oxygenation, cognitive performance and brain morphometric parameters in HD patients.
METHODS: In this cross-sectional study, we enrolled 44 HD patients (24 males, 20 females; mean age 72.5 ± 17.5 years) and 24 healthy controls of similar age. All patients had received HD for more than three months. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Frontal lobe oxygenation was measured with the INVOS 5100C Oximetry system. Brain morphology was evaluated using MRI on a Magnetom Sola 1.5 T scanner, processed with MorphoBox software.
RESULTS: The HD group showed lower rSO2 (p < 0.001), worse cognitive scores (p < 0.001), and significant brain structural changes including reduced white (p = 0.005) and grey (p = 0.002) matter volumes, more extensive white matter hyperintensities (p = 0.04), microbleeds (p = 0.001), and lacunar infarcts (p = 0.003). MoCA and rSO2 values were positively correlated in controls (Spearman rho = 0.411, p = 0.046), but not in HD patients. In the HD group, MoCA scores significantly correlated with brain structural parameters (p < 0.05).
CONCLUSION: HD patients had impaired cognition, lower cerebral oxygenation, and marked structural brain changes. However, regional frontal cerebral hypoxia was not associated with cognitive decline or brain structural changes in HD patients.
METHODS: In this cross-sectional study, we enrolled 44 HD patients (24 males, 20 females; mean age 72.5 ± 17.5 years) and 24 healthy controls of similar age. All patients had received HD for more than three months. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Frontal lobe oxygenation was measured with the INVOS 5100C Oximetry system. Brain morphology was evaluated using MRI on a Magnetom Sola 1.5 T scanner, processed with MorphoBox software.
RESULTS: The HD group showed lower rSO2 (p < 0.001), worse cognitive scores (p < 0.001), and significant brain structural changes including reduced white (p = 0.005) and grey (p = 0.002) matter volumes, more extensive white matter hyperintensities (p = 0.04), microbleeds (p = 0.001), and lacunar infarcts (p = 0.003). MoCA and rSO2 values were positively correlated in controls (Spearman rho = 0.411, p = 0.046), but not in HD patients. In the HD group, MoCA scores significantly correlated with brain structural parameters (p < 0.05).
CONCLUSION: HD patients had impaired cognition, lower cerebral oxygenation, and marked structural brain changes. However, regional frontal cerebral hypoxia was not associated with cognitive decline or brain structural changes in HD patients.