Cognitive Impairment in Chronic Kidney Disease Is Associated with Glymphatic System Dysfunction

Shuqin Xu; Jiuqi Wang; Kedi Sun; Lin Meng; Chi Qin; Renyi Feng; Yiming Tian; Yanping Zhai; Dongxiao Liang; Rui Zhang; Haiyan Tian; Han Liu; Yongkang Chen; Yu Fu; Pei Chen; Qingyong Zhu; Junfang Teng; Xuejing Wang

doi:10.1159/000530635

Cognitive Impairment in Chronic Kidney Disease Is Associated with Glymphatic System Dysfunction

Kidney Dis (Basel). 2023 Jun 14;9(5):384-397. doi: 10.1159/000530635. eCollection 2023 Oct.

Authors

Shuqin Xu^{1

2}, Jiuqi Wang^{1

2}, Kedi Sun^{1

2}, Lin Meng^{1

2}, Chi Qin^{1

2}, Renyi Feng^{1

2}, Yiming Tian^{1

2}, Yanping Zhai^{1

2}, Dongxiao Liang^{1

2}, Rui Zhang^{1

2}, Haiyan Tian^{1

2}, Han Liu^{1

2}, Yongkang Chen^{1

2}, Yu Fu^{1

2}, Pei Chen^{1

2}, Qingyong Zhu^{1

2}, Junfang Teng^{1

2}, Xuejing Wang^{1

2}

Affiliations

¹ Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China.

Abstract

Introduction: This study was designed to explore the associations between impaired cognition in chronic kidney disease (CKD) patients and the dysfunction of the glymphatic system.

Method: Data were obtained from 77 CKD patients and 50 age-matched healthy control individuals from the First Affiliated Hospital of Zhengzhou University. CKD patients were stratified into with and without impaired cognitive function. T2-weighted magnetic resonance imaging results were used to assess area ratios for the perivascular space and ventricles in participants, while the Montreal Cognitive Assessment and the Mini-Mental State Examination were employed to measure cognitive function. Correlations between the perivascular space or ventricle area ratios and cognitive impairment were assessed in CKD patients.

Results: Significant increases in the burden of enlarged perivascular spaces in the frontal cortex and basal ganglia were observed in CKD patients with cognitive impairment relative to those without such impairment, with a concomitant increase in analyzed ventricle area ratios. Enlarged perivascular spaces in the frontal cortex, basal ganglia and increased area ratios of lateral ventricles and 4th ventricle exhibited relatively high sensitivity and specificity as means of differing between the CKD patients with and without cognitive impairment.

Conclusion: These results indicate that the burden of enlarged perivascular spaces in the frontal cortex and basal ganglia and increases in ventricle area ratio values may offer utility as biomarkers that can aid in detection of even mild cognitive decline in individuals with CKD. The dysfunction of the glymphatic system may play a key role in the pathogenesis of CKD-related cognitive impairment.

Keywords: Chronic kidney disease; Cognitive impairment; Glymphatic system; Magnetic resonance imaging; Perivascular spaces.

Grants and funding

This work was supported by grants from the National Natural Science Foundation of China No. 82122022 (to X.J.W.) and No. 81873791 (to X.J.W.). The funding sources supported the roles of the preparation and analysis of data and for the manuscript.