Chronic Kidney Disease Requiring Chronic Dialysis
Conditions
Keywords
brain, haemodialysis, intradialytic hypotension
Brief summary
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.
Detailed description
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.
Interventions
DEVICEMRI
MRI will be performed during interdialysis period in the haemodialysis group. MRI will be performed at the beginning of the study in predialysis group.
Sponsors
Hospital General Universitario Gregorio Marañon
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Prevalent patients of haemodialysis (6 months minimum) * Patients with CKD (stages 4 and 5) * Informed consent signed
Exclusion criteria
* Refusion to participate in the study * Presence of contraindications for MRI * Presence of clinic neurologic disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Morphological changes in gray matter of haemodialysis group | one year | area (mm2), volume (mm3), mean cortical thick (mm) of each structure of brain |
| Morphological changes in white matter of haemodialysis group | one year | Diffusion weighted imaging: fractional anisotropy, median diffusivity, radial diffusivity, volume ratio. |
| Morphological changes in gray matter of predialysis group that start haemodialysis | six months | area (mm2), volume (mm3), mean cortical thick (mm) of each structure of brain |
| Morphological changes in white matter of predialysis group that start haemodialysis | six months | Diffusion weighted imaging: fractional anisotropy, median diffusivity, radial diffusivity, volume ratio. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Related factors that have influence in morphological changes in haemodialysis group | one year | 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). |
| Related factors that have influence in morphological changes in predialysis group | six months | age, etiology of CKD, proteinuria, blood pressure, comorbidities. |
Countries
Spain
Contacts
Primary ContactJuan M. López Gómez, PhD
Backup ContactSantiago Cedeño Mora, MD
Outcome results
None listed