Peritoneal Dialysis Patients Exhibit Quantifiable Neurocognitive Impairment but Not Acute Ischemic Brain Injury: A Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging Study
Bibliographic record
Abstract
Background: Patients receiving hemodialysis (HD) are known to suffer recurrent ischemic multiorgan injury, which effects the vulnerable vascular beds of the brain. These acute cerebral insults are associated with significant white matter (WM) injury, ultimately leading to neurocognitive impairment. PD patients are not subject to the equivalent circulatory stress as HD patients suggesting PD is relatively neuro-protective. Our objective was to utilize an imaging-based approach previously applied to a HD cohort to examine the acute intradialytic effects of PD. Methods: Patients completed a neurocognitive battery (The Montreal Cognitive Assessment (MoCA), Trails Making Test (TMT), and Cambridge Brain Science (CBS)), an intradialytic MRI scan encompassing diffusion tensor imaging (DTI, WM integrity), and a proton magnetic resonance spectroscopy (1H-MRS, neurochemistry). Imaging and neurocognitive assessments were performed before PD exchange, with repeat imaging after 90 minutes of dwell time. Results: 12 patients receiving PD were studied. Patient demographics included (mean±SD): 67±8 years of age, 75% male, 75% diabetic, dialysis vintage 18±10 months, ultrafiltration 0.58±0.36L, and PD exchange 8.3% with 2.5% and 91.7% with 4.25% dextrose. Neurocognitive impairment (%impaired) was evident by the TMTA/B measuring attention (A=92%) and executive function (B=42%). CBS tasks are classified by their contribution to verbal, short-term memory, and reasoning domains. The verbal weighted domain component score demonstrated the most impairment (46%). Finally, 2/12 patients (17%) exhibited global impairment detected by the MoCA. DTI imaging demonstrated no acute effects on WM integrity. However, 1H-MRS detected a 21% increase in brain glucose concentration (p=0.006). Conclusions: PD patients exhibited quantifiable neurocognitive deficits, but did not suffer acute intradialytic WM injury, supporting that PD may have neuro-protective benefits. PD dwell did result in brain hyperglycemia, indicative of acute metabolic stress. This may translate into an alternative hypothesis for progressive neurocognitive impairment via advanced glycation end-products, but further research is necessary. Funding: Private Foundation Support
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".