The purpose of this study is to describe brain´s morphological changes induced by chronic kidney disease (CKD) in advanced stages (stages 4 and 5 defined by KDOQI guidelines) and also by haemodialysis using MRI. Based on the hypothesis that hypotension may cause damage in some organs including brain the investigators study if intradialytic hypotension (IDH) causes any type of changes in gray and white matter of the brain.
There will be two groups: one in haemodialysis treatment and the other with chronic kidney disease patients in advanced stages (stages 4 and 5 defined by KDOQI guidelines). Both groups will be evaluated with a MRI without contrast. A second MRI to identify brain´s morphological changes will be performed in patients of the first group a year later and in patients of the second group that will have been begun haemodialysis six months after. In a first transverse evaluation, eighteen haemodialysis sessions from the first group will be studied with a retrospective analysis. The first three sessions of each month for six months before the MRI will be considered. In each session the investigators will collect haemodynamic variables (systolic arterial blood pressure pre and post dialysis), intradialytic hypotension based on different definitions (Nadir90, Nadir100, Fall20, Fall30) and proper haemodialysis variables (KtV, convective transport). In the first group and patients with CKD that will start haemodialysis, the investigators analyse the variables considered in the transverse evaluation until complete one year follow up. Statistical analysis will be done with SPSS version 20.
Study Type
OBSERVATIONAL
Enrollment
100
MRI will be performed during interdialysis period in the haemodialysis group. MRI will be performed at the beginning of the study in predialysis group.
Hospital General Universitario Gregorio Marañon
Madrid, Spain
RECRUITINGMorphological changes in gray matter of haemodialysis group
area (mm2), volume (mm3), mean cortical thick (mm) of each structure of brain
Time frame: one year
Morphological changes in white matter of haemodialysis group
Diffusion weighted imaging: fractional anisotropy, median diffusivity, radial diffusivity, volume ratio.
Time frame: one year
Morphological changes in gray matter of predialysis group that start haemodialysis
area (mm2), volume (mm3), mean cortical thick (mm) of each structure of brain
Time frame: six months
Morphological changes in white matter of predialysis group that start haemodialysis
Diffusion weighted imaging: fractional anisotropy, median diffusivity, radial diffusivity, volume ratio.
Time frame: six months
Related factors that have influence in morphological changes in haemodialysis group
age (years), time in dialysis (months), time of treatment (hours), KtV, convective transport (L/session), anemia (hemoglobin, index resistance erythropoietin), inflammation (PCR), intradialytic hypotension (Nadir90, Nadir100, Fall20, Fall30).
Time frame: one year
Related factors that have influence in morphological changes in predialysis group
age, etiology of CKD, proteinuria, blood pressure, comorbidities.
Time frame: six months
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