Journal of Brain and Neurology

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.
Reach Us +1 (202) 780-3397

Commentary - Journal of Brain and Neurology (2023) Volume 6, Issue 4

Morphological brain alterations in dialysis- and non-dialysis-dependent patients

Rexa Torres *

Department of Neurosciences

*Corresponding Author:
Rexa Torres
Department of Neurosciences
University of Colorado School of Medicine
United States
E-mail: torresrex@cuanschutz.edu

Received:30-Jun-2023, Manuscript No. AAJBN-23-105466; Editor assigned:03-Jul-2023, PreQC No. AAJBN-23-105466 (PQ); Reviewed:17-Jul-2023, QC No. AAJBN-23-105466; Revised:20-Jul-2023, Manuscript No. AAJBN-23-105466 (R); Published:27-Jul-2023, DOI: 10.35841/aajbn-6.4.153

Citation: Torres R. Morphological brain alterations in dialysis- and non-dialysis-dependent patients. J Brain Neurol. 2023;6(4):153

Visit for more related articles at Journal of Brain and Neurology

Introduction

Chronic kidney disease (CKD) affects millions of people worldwide and is associated with various complications, including cognitive impairment. One of the most common treatments for end-stage renal disease (ESRD) is dialysis, a process that helps remove waste products and excess fluids from the body. While dialysis plays a vital role in sustaining the lives of patients, recent research has focused on understanding the potential impact of dialysis on the brain's morphology and cognitive function. This article delves into the morphological brain alterations observed in dialysis- and non-dialysis-dependent patients and explores their implications. Given the high prevalence of cognitive impairment in CKD patients, it is essential to implement strategies to manage and potentially improve cognitive function. The multidimensional nature of cognitive impairment in CKD requires a comprehensive approach involving both non-pharmacological and pharmacological interventions [1].

Cognitive impairment is a common complication in CKD patients, affecting up to 60% of individuals undergoing dialysis. These cognitive deficits can range from mild cognitive impairment (MCI) to severe dementia. The causes of cognitive impairment in CKD are multifactorial and include vascular factors, inflammation, uremic toxins, anemia, and metabolic imbalances. However, the potential contribution of morphological brain alterations to cognitive dysfunction has gained significant attention. Several studies using advanced neuroimaging techniques, such as magnetic resonance imaging (MRI), have revealed structural brain changes in dialysis patients [2].

These alterations include cortical and subcortical atrophy, white matter abnormalities, and increased cerebrovascular disease burden. Dialysis-dependent patients often exhibit reduced cortical and subcortical volumes compared to healthy controls. The atrophy is most prominent in brain regions associated with cognition, such as the prefrontal cortex, temporal lobes, and hippocampus. These changes are indicative of neurodegenerative processes and are consistent with the observed cognitive deficits. White matter abnormalities, including demyelination, axonal loss, and decreased white matter integrity, are commonly observed in dialysis patients. These alterations disrupt the connectivity between different brain regions, leading to impaired information processing and cognitive dysfunction [3].

ESRD and dialysis patients are at an increased risk of cerebrovascular diseases, including stroke and small vessel disease. These conditions contribute to the morphological brain alterations seen in these patients. Chronic hypoperfusion and vascular damage can lead to lacunar infarcts, microbleeds, and white matter hyperintensities, all of which have been associated with cognitive decline. While dialysis is known to have a significant impact on brain morphology, it is important to note that non-dialysis-dependent CKD patients also show structural brain alterations. Studies have revealed similar patterns of cortical and subcortical atrophy, white matter abnormalities, and cerebrovascular disease burden in this population. Although the extent of these changes may be milder compared to dialysis-dependent patients, they contribute to the overall cognitive impairment observed in CKD [4].

Understanding the impact of structural brain alterations in non-dialysis-dependent CKD patients is crucial for comprehensive management and early intervention. Although the extent of morphological changes may be milder compared to dialysis-dependent patients, they still contribute to cognitive impairment and warrant attention. Regular monitoring of cognitive function in non-dialysis-dependent CKD patients can help identify early signs of cognitive decline. This can be achieved through cognitive screening tests and assessments performed by healthcare professionals. Early detection allows for timely intervention strategies to be implemented, potentially slowing down the progression of cognitive impairment. Additionally, management of modifiable risk factors associated with structural brain alterations can help preserve cognitive function in non-dialysis-dependent CKD patients. Lifestyle modifications, such as adopting a healthy diet and engaging in regular physical exercise, play an important role in maintaining overall brain health. Controlling vascular risk factors like hypertension, diabetes, and dyslipidemia can also have a positive impact on brain morphology and cognitive function.

In cases where cognitive impairment becomes significant and affects the quality of life, pharmacological interventions may be considered. The selection of medications should be done cautiously, taking into account the individual patient's overall health and comorbidities. Close monitoring of medication effects and potential side effects is essential. Furthermore, non-dialysis-dependent CKD patients should be encouraged to participate in cognitive rehabilitation programs and engage in mentally stimulating activities. These interventions can help optimize cognitive function, improve memory, attention, and executive functioning. The morphological brain alterations seen in both dialysis- and non-dialysis-dependent CKD patients have important implications for cognitive function. The cortical and subcortical atrophy, white matter abnormalities, and cerebrovascular disease burden likely contribute to the cognitive deficits observed in these patients. Understanding these structural changes is crucial for early identification, monitoring, and intervention strategies aimed at preserving cognitive function in CKD patients [5].

Conclusion

Chronic kidney disease, especially in its advanced stages requiring dialysis, is associated with significant morphological brain alterations. These changes include cortical and subcortical atrophy, white matter abnormalities, and an increased burden of cerebrovascular disease. These alterations are likely responsible, at least in part, for the cognitive impairment observed in dialysis- and non-dialysis-dependent CKD patients. Further research is needed to explore the underlying mechanisms and develop targeted interventions to mitigate the impact of these brain alterations on cognitive function .

References

  1. Hingwala J, Wojciechowski P, Hiebert B, et al. Risk-based triage for nephrology referrals using the kidney failure risk equation. Can J Kidney Health Dis. 2017;4:2054358117722782.

    2. Indexed at, Google Scholar, Cross Ref

  2. Smekal MD, Tam-Tham H, Finlay J, et al. Patient and provider experience and perspectives of a risk-based approach to multidisciplinary chronic kidney disease care: a mixed methods study. BMC nephrology. 2019;20(1):1-2.

    3. Indexed at, Google Scholar, Cross Ref

  3. Harasemiw O, Drummond N, Singer A, et al. Integrating risk-based care for patients with chronic kidney disease in the community: study protocol for a cluster randomized trial. Can J Kidney Health Dis. 2019;6:2054358119841611

    4. Indexed at, Google Scholar, Cross Ref

  4. Grams ME, Sang Y, Ballew SH, et al. Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate . Kidney Int. 2018;93(6):1442-51.

    5. Indexed at, Google Scholar, Cross Ref

  5. Eckardt KU, Bansal N, Coresh J, et al. Improving the prognosis of patients with severely decreased glomerular filtration rate (CKD G4+): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference . Kidney Int. 2018;93(6):1281-92.

    6. Indexed at, Google Scholar, Cross Ref

Get the App