School of Medicine and Health Sciences Poster Presentations
Impact of Nondiabetic End Stage Renal Disease on Brain Parenchyma
Poster Number
236
Document Type
Poster
Publication Date
3-2016
Abstract
PURPOSE
The effects of diabetes mellitus (DM) on the cerebrovascular physiology have been well established. DM accelerates atherosclerotic disease, which in turn results in various insults to the brain. While many patients with DM suffer from chronic renal disease (CRD), end stage renal disease (ESRD) is not always caused by DM. The effect of ESRD in nonDM patients on the brain has not been elucidated. We tested the hypothesis that the brains of patients with nonDM-ESRD are affected differently as compared to those with DM-ESRD.
METHOD AND MATERIALS
We screened about 1500 patients with CRD. 53 patients with ESRD had a brain MRI at our center. Age, gender, blood pressure, HbA1c and BMI were recorded. Also brain MRI of these patients were reviewed for cerebral volume loss graded subjectively as mild, moderate and severe; 3rd ventricle diameter; white matter changes based on Fazekas scale and the presence or absence of lacunar and territorial infarcts.
RESULTS
29 patients have DM and 24 do not. There is no significant difference in the mean age, gender, mean blood pressures in the two groups. The mean BMI for DM and nonDM groups were 31 and 26 respectively (p=0.07). 83% of the DM patients had periventricular white matter lesions with Fazekas grade 2 or above compared to 50% in the nonDM group(p=0.03). 62% patients in the DM group had moderate cerebral volume loss with mean 3rd ventricle size of 7mm versus 50% in the nonDM group with mean 3rd ventricle size of 6mm (p=0.36). 62% of patients had lacunar infarcts and 34% had territorial infarcts in the DM group versus 46% with lacunar infarcts and 25% with territorial infarcts in the nonDM group(p>0.2).
CONCLUSION
The degree of periventricular white matter (PVWM) changes was statistically more severe in patients with DM. Although the lacunar and territorial infarcts and the mean cerebral volume loss were lower in the nonDM group, this difference was not statistically significant. This study supports the prior observations that PVWM changes are likely related to chronic microvascular ischemia. This type of pathology appears more prevalent in patients with ESRD secondary to DM than those with nonDM ESRD.
CLINICAL RELEVANCE/APPLICATION
This study suggests that the mechanism by which the brain parenchyma is affected in nonDM-ESRD group is different than those with DM. Studies are being undertaken to further characterize the causes of brain injury in this patient population in the hopes of finding ways to slow the disease progression.
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Open Access
1
Impact of Nondiabetic End Stage Renal Disease on Brain Parenchyma
PURPOSE
The effects of diabetes mellitus (DM) on the cerebrovascular physiology have been well established. DM accelerates atherosclerotic disease, which in turn results in various insults to the brain. While many patients with DM suffer from chronic renal disease (CRD), end stage renal disease (ESRD) is not always caused by DM. The effect of ESRD in nonDM patients on the brain has not been elucidated. We tested the hypothesis that the brains of patients with nonDM-ESRD are affected differently as compared to those with DM-ESRD.
METHOD AND MATERIALS
We screened about 1500 patients with CRD. 53 patients with ESRD had a brain MRI at our center. Age, gender, blood pressure, HbA1c and BMI were recorded. Also brain MRI of these patients were reviewed for cerebral volume loss graded subjectively as mild, moderate and severe; 3rd ventricle diameter; white matter changes based on Fazekas scale and the presence or absence of lacunar and territorial infarcts.
RESULTS
29 patients have DM and 24 do not. There is no significant difference in the mean age, gender, mean blood pressures in the two groups. The mean BMI for DM and nonDM groups were 31 and 26 respectively (p=0.07). 83% of the DM patients had periventricular white matter lesions with Fazekas grade 2 or above compared to 50% in the nonDM group(p=0.03). 62% patients in the DM group had moderate cerebral volume loss with mean 3rd ventricle size of 7mm versus 50% in the nonDM group with mean 3rd ventricle size of 6mm (p=0.36). 62% of patients had lacunar infarcts and 34% had territorial infarcts in the DM group versus 46% with lacunar infarcts and 25% with territorial infarcts in the nonDM group(p>0.2).
CONCLUSION
The degree of periventricular white matter (PVWM) changes was statistically more severe in patients with DM. Although the lacunar and territorial infarcts and the mean cerebral volume loss were lower in the nonDM group, this difference was not statistically significant. This study supports the prior observations that PVWM changes are likely related to chronic microvascular ischemia. This type of pathology appears more prevalent in patients with ESRD secondary to DM than those with nonDM ESRD.
CLINICAL RELEVANCE/APPLICATION
This study suggests that the mechanism by which the brain parenchyma is affected in nonDM-ESRD group is different than those with DM. Studies are being undertaken to further characterize the causes of brain injury in this patient population in the hopes of finding ways to slow the disease progression.
Comments
Presented at: GW Research Days 2016.