Abstract
Background
Chronic kidney disease (CKD) is a risk factor for vascular disease and stroke. The spectrum of brain injury and microstructural white matter abnormalities in children with CKD is largely unknown.
Methods
Cross sectional study at two North American pediatric hospitals. A cohort of 49 children, 29 with CKD, including renal transplant (mean age 14.4 ± 2.9 years; range 9–18), and 20 healthy controls (mean age 13.7 ± 3.1 years; range 9–18) had their conventional brain magnetic resonance images (MRIs) reviewed by one neuroradiologist to determine the prevalence of brain injury. Fractional anisotropy (FA) maps calculated from diffusion tensor imaging (DTI) were generated to compare white matter microstructure in CKD compared to controls, using tract-based spatial statistics (TBSS).
Results
Focal and multifocal white matter injury was seen on brain MRI in 6 children with CKD (21%). Relative to controls, CKD subjects showed reduced white matter fractional anisotropy and increased mean diffusivity and radial diffusivity in the anterior limb of the internal capsule, suggestive of abnormal myelination.
Conclusion
Cerebral white matter abnormalities, including white matter injury, are under-recognized in pediatric CKD patients. Brain imaging studies through progression of CKD are needed to determine the timing of white matter injury and any potentially modifiable risk factors.
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Funding
This study was funded by the British Columbia Children’s Hospital Telethon Foundation Grant, by the Renal Research Institute at the University of North Carolina School of Medicine, and by NCTraCTS Institute at the University of North Carolina School of Medicine. Additional support for completion of the data analyses and for some of the data collected for this manuscript was provided by the Chronic Kidney Disease in children prospective cohort study (CKiD), with Principal Investigators at Children’s Mercy Hospital and the University of Missouri—Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia (Susan Furth, MD, Ph.D.). The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01-DK-082194, and U01-DK-66116). The CKiD website is located at http://www.statepi.jhsph.edu/ckid. The funders of this study had no role in the study design, data collection or analysis, interpretation of data, or writing the report; or the decision to submit the report for publication.
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Matsuda-Abedini, M., Fitzpatrick, K., Harrell, W.R. et al. Brain abnormalities in children and adolescents with chronic kidney disease. Pediatr Res 84, 387–392 (2018). https://doi.org/10.1038/s41390-018-0037-5
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DOI: https://doi.org/10.1038/s41390-018-0037-5
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