Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Subject Collections
    • JASN Podcasts
    • Archives
    • Saved Searches
    • ASN Meeting Abstracts
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Editorial Team
  • Subscriptions
  • More
    • About JASN
    • Alerts
    • Advertising
    • Editorial Fellowship Program
    • Feedback
    • Reprints
    • Impact Factor
  • ASN Kidney News
  • Other
    • CJASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • CJASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Subject Collections
    • JASN Podcasts
    • Archives
    • Saved Searches
    • ASN Meeting Abstracts
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Editorial Team
  • Subscriptions
  • More
    • About JASN
    • Alerts
    • Advertising
    • Editorial Fellowship Program
    • Feedback
    • Reprints
    • Impact Factor
  • ASN Kidney News
  • Follow JASN on Twitter
  • Visit ASN on Facebook
  • Follow JASN on RSS
  • Community Forum
Clinical Research
You have accessRestricted Access

Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation

Rebecca J. Lepping, Robert N. Montgomery, Palash Sharma, Jonathan D. Mahnken, Eric D. Vidoni, In-Young Choi, Mark J. Sarnak, William M. Brooks, Jeffrey M. Burns and Aditi Gupta
JASN January 2021, 32 (1) 177-187; DOI: https://doi.org/10.1681/ASN.2020050584
Rebecca J. Lepping
1Hoglund Biomedical Imaging Center, Kansas City, Kansas
2University of Kansas Alzheimer’s Disease Center, Fairway, Kansas
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Rebecca J. Lepping
Robert N. Montgomery
3Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Palash Sharma
3Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jonathan D. Mahnken
2University of Kansas Alzheimer’s Disease Center, Fairway, Kansas
3Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Eric D. Vidoni
2University of Kansas Alzheimer’s Disease Center, Fairway, Kansas
4Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Eric D. Vidoni
In-Young Choi
1Hoglund Biomedical Imaging Center, Kansas City, Kansas
4Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mark J. Sarnak
5Division of Nephrology and Hypertension, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Mark J. Sarnak
William M. Brooks
1Hoglund Biomedical Imaging Center, Kansas City, Kansas
2University of Kansas Alzheimer’s Disease Center, Fairway, Kansas
4Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
6Frontiers: University of Kanas Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jeffrey M. Burns
2University of Kansas Alzheimer’s Disease Center, Fairway, Kansas
4Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
6Frontiers: University of Kanas Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Aditi Gupta
2University of Kansas Alzheimer’s Disease Center, Fairway, Kansas
7Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
8The Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Aditi Gupta
  • Article
  • Figures & Data Supps
  • Info & Metrics
  • View PDF
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Visual Abstract

Figure1
  • Download figure
  • Open in new tab
  • Download powerpoint

Significance Statement

Kidney disease is accompanied by structural and physiologic brain abnormalities and increased risk of dementia and stroke. Because RRT with dialysis does not normalize these brain abnormalities, the authors evaluated the possible benefit of kidney transplantation. Using magnetic resonance imaging methods to measure brain abnormalities before and after kidney transplantation, they demonstrated that this intervention normalizes cerebral blood flow, neurochemical concentrations, and white matter integrity. They also found that these changes persist beyond the initial post-transplantation period and thus, cannot be attributed to periprocedural interventions, such as steroids. Their findings suggest that brain abnormalities in kidney disease may be reversible. Further studies are needed to understand the mechanisms underlying these brain abnormalities and to explore interventions to prevent and mitigate them in patients who cannot undergo kidney transplantation.

Abstract

Background CKD is associated with abnormalities in cerebral blood flow, cerebral neurochemical concentrations, and white matter integrity. Each of these is associated with adverse clinical consequences in the non-CKD population, which may explain the high prevalence of dementia and stroke in ESKD. Because cognition improves after kidney transplantation, comparing these brain abnormalities before and after kidney transplantation may identify potential reversibility in ESKD-associated brain abnormalities.

Methods In this study of patients with ESKD and age-matched healthy controls, we used arterial spin labeling to assess the effects of kidney transplantation on cerebral blood flow and magnetic resonance spectroscopic imaging to measure cerebral neurochemical concentrations (N-acetylaspartate, choline, glutamate, glutamine, myo-inositol, and total creatine). We also assessed white matter integrity measured by fractional anisotropy (FA) and mean diffusivity (MD) with diffusion tensor imaging. We used a linear mixed model analysis to compare longitudinal, repeated brain magnetic resonance imaging measurements before, 3 months after, and 12 months after transplantation and compared these findings with those of healthy controls.

Results Study participants included 29 patients with ESKD and 19 controls; 22 patients completed post-transplant magnetic resonance imaging. Cerebral blood flow, which was higher in patients pretransplant compared with controls (P=0.003), decreased post-transplant (P<0.001) to values in controls. Concentrations of neurochemicals choline and myo-inositol that were higher pretransplant compared with controls (P=0.001 and P<0.001, respectively) also normalized post-transplant (P<0.001 and P<0.001, respectively). FA increased (P=0.001) and MD decreased (P<0.001) post-transplant.

Conclusions Certain brain abnormalities in CKD are reversible and normalize with kidney transplantation. Further studies are needed to understand the mechanisms underlying these brain abnormalities and to explore interventions to mitigate them even in patients who cannot be transplanted.

Clinical Trial registry name and registration number: Cognitive Impairment and Imaging Correlates in End Stage Renal Disease, NCT01883349

  • ESKD
  • kidney transplantation
  • cerebral blood flow
  • neurochemicals
  • white matter integrity
  • ASL
  • MRSI
  • DTI
  • Copyright © 2021 by the American Society of Nephrology
View Full Text

Log in using your username and password

Forgot your user name or password?

Log in through your institution

You may be able to gain access using your login credentials for your institution. Contact your library if you do not have a username and password.

Purchase access

You will have access to the article for 24 hours.  

If you do not have an account, you will need to create one and you will be asked for your name, email address and other information.  Just like commercial web sites, we do need details from you in order to complete your purchase of an article.  Select the "Create an Account" link to create your account. 

You will then be asked to register a user name, email address and you will need to create a password that is at least eight characters in length. As you move through the registration page, you will have to verify you are a person by completing a Captcha request.   Lastly, your first and last name will be required. 

Once your information is successfully saved, the system will redisplay the home page of the journal.  From there, navigate back to the article to purchase.  Select the article and at the bottom of the page, use the credentials you just created to login. The article will be added to your shopping cart.  You can continue to navigate across JASN and CJASN adding to your cart from both journals. When you are ready to complete your purchse, select the Shopping Cart from the upper right hand corner of the page and follow the onscreen instructions. 

PreviousNext
Back to top

In this issue

Journal of the American Society of Nephrology: 32 (1)
Journal of the American Society of Nephrology
Vol. 32, Issue 1
January 2021
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
View Selected Citations (0)
Print
Download PDF
Sign up for Alerts
Email Article
Thank you for your help in sharing the high-quality science in JASN.
Enter multiple addresses on separate lines or separate them with commas.
Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation
(Your Name) has sent you a message from American Society of Nephrology
(Your Name) thought you would like to see the American Society of Nephrology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation
Rebecca J. Lepping, Robert N. Montgomery, Palash Sharma, Jonathan D. Mahnken, Eric D. Vidoni, In-Young Choi, Mark J. Sarnak, William M. Brooks, Jeffrey M. Burns, Aditi Gupta
JASN Jan 2021, 32 (1) 177-187; DOI: 10.1681/ASN.2020050584

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Request Permissions
Share
Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation
Rebecca J. Lepping, Robert N. Montgomery, Palash Sharma, Jonathan D. Mahnken, Eric D. Vidoni, In-Young Choi, Mark J. Sarnak, William M. Brooks, Jeffrey M. Burns, Aditi Gupta
JASN Jan 2021, 32 (1) 177-187; DOI: 10.1681/ASN.2020050584
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Visual Abstract
    • Abstract
    • Methods
    • Results
    • Discussion
    • Disclosures
    • Funding
    • Acknowledgments
    • Supplemental Material
    • Footnotes
    • References
  • Figures & Data Supps
  • Info & Metrics
  • View PDF

More in this TOC Section

  • Missing Self-Induced Activation of NK Cells Combines with Non-Complement-Fixing Donor-Specific Antibodies to Accelerate Kidney Transplant Loss in Chronic Antibody-Mediated Rejection
  • AKI in Hospitalized Patients with COVID-19
  • Ziltivekimab for Treatment of Anemia of Inflammation in Patients on Hemodialysis: Results from a Phase 1/2 Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial
Show more Clinical Research

Cited By...

  • No citing articles found.
  • Google Scholar

Similar Articles

Related Articles

  • PubMed
  • Google Scholar

Keywords

  • ESKD
  • kidney transplantation
  • cerebral blood flow
  • neurochemicals
  • white matter integrity
  • ASL
  • MRSI
  • DTI

Articles

  • Current Issue
  • Early Access
  • Subject Collections
  • Article Archive
  • ASN Annual Meeting Abstracts

Information for Authors

  • Submit a Manuscript
  • Author Resources
  • Editorial Fellowship Program
  • ASN Journal Policies
  • Reuse/Reprint Policy

About

  • JASN
  • ASN
  • ASN Journals
  • ASN Kidney News

Journal Information

  • About JASN
  • JASN Email Alerts
  • JASN Key Impact Information
  • JASN Podcasts
  • JASN RSS Feeds
  • Editorial Board

More Information

  • Advertise
  • ASN Podcasts
  • ASN Publications
  • Become an ASN Member
  • Feedback
  • Follow on Twitter
  • Password/Email Address Changes
  • Subscribe

© 2021 American Society of Nephrology

Print ISSN - 1046-6673 Online ISSN - 1533-3450

Powered by HighWire