Читать книгу Recent Advances in Dialysis Therapy in Japan - Группа авторов - Страница 64

A recent analysis of brain MRI images using the statistical parametric mapping (SPM) approach showed that gray matter volume decreases with aging while white matter volume remains unchanged [2]. We analyzed brain MRI images of non-dialysis-dependent CKD patients and those of patients undergoing peritoneal dialysis (PD) using SPM to compare the brain volumes and percentage changes in brain volume between these two groups.

An initial cross-sectional analysis in 69 patients with non-dialysis-dependent CKD (mean age 61 ± 10 years, 37 males and 32 females, estimated glomerular filtration rate [eGFR]: 39 ± 12 mL/min/1.73 m²) and 62 patients undergoing PD (mean age 60 ± 12 years, 41 males and 21 females) showed a significant inverse correlation between age and the gray matter volume ratio (GMR), but not the white matter volume ratio. In terms of the relationship between GMR and age, the regression line for PD patients was below that of non-dialysis-dependent CKD patients, meaning lower GMR in PD patients in the same age group, and the difference became larger with increasing age (Fig. 2) [3].

Next, when the annual change in GMR was compared between 61 non-dialysis-dependent CKD patients (mean age 61 ± 10 years, 32 males and 29 females, eGFR: 39 ± 12 mL/min/1.73 m²) and 34 PD patients (mean age 60 ± 11 years, 21 males and 13 females) who underwent another brain MRI 2 years later, the least square mean of the annual change in GMR was –0.38 ± 0.10% in non-dialysis-dependent CKD and –0.83 ± 0.14% in PD patients, indicating progression of brain atrophy to be faster, i.e. by a rate of more than twofold, in PD patients (Fig. 3) [3]. Given that the GMR in normal individuals decreases with age at a rate of 0.2–0.3%/year, as reported by Taki et al. [2], brain atrophy in PD patients progresses 3 times faster than that in normal individuals.