Anatomic brain disease in hemodialysis patients: a cross-sectional study.
Anatomic brain disease in hemodialysis patients: a cross-sectional study.
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DOI：
10.1053/j.ajkd.2012.08.035
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发表时间：
2013-02
期刊：
影响因子：
--
通讯作者：
Sarnak MJ
中科院分区：
文献类型：
--
作者：
Drew DA;Bhadelia R;Tighiouart H;Novak V;Scott TM;Lou KV;Shaffi K;Weiner DE;Sarnak MJ
虽然透析患者中风风险高，认知障碍负担重，但很少有关于血液透析人群脑解剖结果的报道。使用脑磁共振成像（MRI），我们比较了血液透析患者和没有已知肾脏疾病的对照人群中脑异常的患病率。横断面队列。45例维持性血液透析患者和67例对照组无肾脏疾病报告，均无已知的卒中史。主要预测因子是透析状态。协变量包括人口统计学（年龄、种族、性别）、血管危险因素（糖尿病和高血压）和心血管疾病（冠状动脉疾病、充血性心力衰竭）。脑MRI特征包括白质疾病和脑萎缩（脑沟突出和脑室萎缩）的严重程度、海马大小和小/大血管梗死。半定量量表（白质疾病和脑萎缩0-9分，海马大小0-3分）和梗死发生率。血液透析组和对照组的平均年龄分别为55±17岁和53±13岁。与对照组相比，血液透析患者出现更严重的白质病变（1.6 v 0.7）和脑萎缩（脑沟突出= 2.3 v 0.6；心室增大= 2.3 v 0.9；海马大小= 1.3 v 1.0）， p值均<0.001。在多变量分析中，血液透析状态与更严重的白质疾病和萎缩等级独立相关。血液透析患者的小血管梗死发生率（17.8%）和大血管梗死发生率（7.8%）也高于对照组（22% vs 0%, p<0.001）。透析队列可能比美国整体血液透析人群更健康，部分限制了普遍性。与没有已知肾脏疾病的对照组相比，血液透析患者有更多的白质疾病和脑萎缩。血液透析患者也有高患病率的未被识别的梗塞。
Although dialysis patients are at high risk for stroke and have a high burden of cognitive impairment, there are few reports on anatomic brain findings in the hemodialysis population. Using brain magnetic resonance imaging (MRI), we compared the prevalence of brain abnormalities in hemodialysis patients to a control population without known kidney disease. Cross-sectional cohort. 45 maintenance hemodialysis patients and 67 controls without reported kidney disease, both without prior history of known stroke. The primary predictor was dialysis status. Covariates included demographics (age, race, sex), vascular risk factors (diabetes and hypertension) and cardiovascular disease (coronary artery disease, congestive heart failure). Brain MRI features including severity of white matter disease and cerebral atrophy (sulcal prominence and ventricular atrophy), hippocampal size, and small/large vessel infarcts. Semi-quantitative scale (0-9 for white matter disease and cerebral atrophy, 0-3 for hippocampal size) and infarct prevalence. The mean age of hemodialysis patients and controls was 55 ± 17 (SD) and 53 ± 13 years, respectively. In comparison with controls, hemodialysis patients had more severe white matter disease (1.6 v 0.7) and cerebral atrophy (sulcal prominence = 2.3 v 0.6; ventricular enlargement = 2.3 v 0.9; hippocampal size = 1.3 v 1.0) with all p-values <0.001. In multivariable analyses, hemodialysis status was independently associated with worse white matter disease and atrophy grades. Hemodialysis patients also had a higher prevalence of small (17.8%) and large (7.8%) vessel infarcts than controls (combined 22% vs 0%, p<0.001). The dialysis cohort is likely healthier than the overall US hemodialysis population, partly limiting generalizability. Hemodialysis patients have more white matter disease and cerebral atrophy compared to controls without known kidney disease. Hemodialysis patients also have a high prevalence of unrecognized infarcts.
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影响因子：
19.7
作者：
GEISSLER, A;FRUND, R;FEUERBACH, S
通讯作者：
FEUERBACH, S
影响因子：
6.1
作者：
Guérin, AP;London, GM;Metivier, F
通讯作者：
Metivier, F
影响因子：
3.1
作者：
Grundman, M;Lack, CR;Thal, LJ
通讯作者：
Thal, LJ
影响因子：
13.2
作者：
Ishida, I;Hirakata, H;Fujishima, M
通讯作者：
Fujishima, M
影响因子：
9.9
作者：
SCHMIDT, R;FAZEKAS, F;LECHNER, H
通讯作者：
LECHNER, H