Diffusion tensor imaging of white matter changes in end stage renal disease

End stage renal disease results (ESRD) in excessive accumulation of urea and toxic metabolites and patients with ESRD encounter uremic neuropathy besides multi system disfunction. Hemodialysis is usually performed to maintain health in patients with ESRD; however, there can be silent white matter alterations in the earlier stages. The purpose of this investigation was to examine the association between cognitive disorders and microstructural white matter (WM) changes in maintenance hemodialysis end-stage renal disease patients using diffusion tensor imaging (DTI). This study was approved by Baskent University Hospital institutional review board; written informed consent was obtained from all patients and control group subjects. Between October 2014 - December 2015 twenty six patients with ESRDundergoing hemodialysis at least one year and twenty six age and sex-matched control subjects were enrolled in this study. Each participant underwent Mini Mental State Examination (MMSE), brain MRI and diffusion tensor imaging. fractional anisotropy (FA) and apparent diffusion coefficient (ADC) indices were calculated from genu and splenium corpus callosum, bilateral anterior and posterior corona radiata, bilateral white matters of frontal, parietal, temporal and occipital lobes using 1,5 T MR scanner. The measurements were made by an experienced neuroradiologist. FA and ADC difference between the 2 groups were compared. We also investigated the associations of FA values in WM regions with ages, MMSE, and dialysis durations of ESRD patients. Compared to control group ESRD patients had statistically significant lower FA value in left frontal white matter, left parietal white matter, right occipital white matter, right temporal white matter and left temporal white matter (p < 0,05). In ESRD group according to multiple regression analysis, FA values showed moderate correlations with age in genu corpus callosum and left frontal white matter and FA decreased with age in these regions. Also FA showed moderate positive correlations with MMSE scores in splenium corpus callosum, left posterior corona radiata, left frontal white matter, right temporal white matter and left temporal white matter. In left frontal white matter and right temporal white matter FA decreased moderately as the duration of hemodialysis increases. ADC values were higher in ESRD group compared to controls in genu corpus callosum, right posterior corona radiata, right and left anterior corona radiata, right and left frontal white matter, and right temporal white matter (p < 0,05). Structural damages in white matter regions, caused by brain edema and demyelination may account for the cognitive deficits in ESRD patients. In the present study we concluded that DTI analysis is helpful in the detection of white matter alterations caused by hemodialysis. Changes in FA values may be used to follow-up white matter changes in patients with ESRD who undergo maintenance dialysis.