Chronic Disease Control

Association of intradialytic cerebral blood flow changes with white matter hyperintensities in hemodialysis patients

  • Xiaoling ZHOU ,
  • Yidan GUO ,
  • Chunxia ZHANG ,
  • Meng JIA ,
  • Zhihua SHI ,
  • Jingying SUN ,
  • Xiyou ZHANG ,
  • Xinyu SONG ,
  • Yang LUO
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  • Department of Nephrology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,Beijing,China

Received date: 2026-03-13

  Online published: 2026-06-30

Abstract

Objective To investigate the association between cerebral blood flow during hemodialysis and white matter hyperintensities (WMHs) in hemodialysis patients. Methods A total of 105 hemodialysis patients from Beijing Shijitan Hospital were enrolled and divided into the WMHs group (n = 57) and the non-WMHs group (n = 48) based on the presence or absence of white matter hyperintensities. The mean flow velocity (MFV) of the middle cerebral artery during dialysis was measured using transcranial Doppler (TCD), and the MFV reduction rate was calculated. Clinical data were compared between the two groups. Risk factors for WMHs were analyzed. Moreover, the association between the MFV reduction rate and the severity of WMHs was explored, and the predictive value of the MFV reduction rate for WMHs was evaluated. Results Age, dialysis vintage, and the reduction rate of MFV were significantly higher in the WMHs group compared to the non-WMHs group (P < 0.05). Multivariate logistic regression analysis indicated that the reduction rate of MFV was an independent risk factor for WMHs (P < 0.05). Multivariate linear regression analysis demonstrated that the reduction rate of MFV was independently associated with the Fazekas score of WMHs. The area under the curve of the reduction rate of MFV for predicting WMHs was 0.806. Conclusion Cerebral blood flow reduction during hemodialysis is significantly associated with white matter hyperintensities WMHs.

Cite this article

Xiaoling ZHOU , Yidan GUO , Chunxia ZHANG , Meng JIA , Zhihua SHI , Jingying SUN , Xiyou ZHANG , Xinyu SONG , Yang LUO . Association of intradialytic cerebral blood flow changes with white matter hyperintensities in hemodialysis patients[J]. The Journal of Practical Medicine, 2026 , 42(12) : 2246 -2251 . DOI: 10.3969/j.issn.1006-5725.2026.12.021

References

[1] OCAK G, BOENINK R, NOORDZIJ M, et al. Trends in mortality due to myocardial infarction, stroke, and pulmonary embolism in patients receiving dialysis[J]. JAMA Netw Open, 2022, 5(4): e227624. doi:10.1001/jamanetworkopen.2022.7624 .
[2] KELLY D M, ADEMI Z, DOEHNER W, et al. Chronic kidney disease and cerebrovascular disease: Consensus and guidance from a KDIGO controversies conference[J]. Stroke, 2021, 52(7): e328-e346. doi:10.1161/strokeaha.120.029680 .
[3] MARKUS H S, DE LEEUW F E. Cerebral small vessel disease: Recent advances and future directions[J]. Int J Stroke, 2023, 18(1): 4-14. doi:10.1177/17474930221144911 .
[4] CHUNG J, OH H, GWAK D S, et al. Multimodal magnetic resonance imaging signatures of white matter hyperintensities: Mechanistic insights into pathobiological heterogeneity[J]. J Stroke, 2026, 28(1): 1-28. doi:10.5853/jos.2025.04168 .
[5] 陈玮琪, 徐佳洁, 陆瑶, 等. 中国脑小血管病的神经影像学诊断标准及名词标准化定义——来自中国卒中学会的专家共识[J]. 中国卒中杂志, 2024, 19(4): 375-404. doi:10.3969/j.issn.1673-5765.2024.04.002 .
[6] NAGANUMA T, TAKEMOTO Y. Asymptomatic cerebrovascular disease in dialysis patients [J]. Contrib Nephrol, 2018,196:22-26. doi:10.1159/000485692 .
[7] HANNAWI Y. Cerebral small vessel disease: A review of the pathophysiological mechanisms[J]. Transl Stroke Res, 2024, 15(6): 1050-1069. doi:10.1007/s12975-023-01195-9 .
[8] THAMMASART S, HARVEY D J, MAILLARD P, et al. Associations between cerebral blood flow and progression of white matter hyperintensities[J]. Front Neuroimaging, 2025, 3: 1463311. doi:10.3389/fnimg.2024.1463311 .
[9] STEWART C R, STRINGER M S, SHI Y, et al. Associations between white matter hyperintensity burden, cerebral blood flow and transit time in small vessel disease: An updated meta-analysis[J]. Front Neurol, 2021, 12: 647848. doi:10.3389/fneur.2021.647848 .
[10] SPRICK J D, NOCERA J R, HAJJAR I, et al. Cerebral blood flow regulation in end-stage kidney disease[J]. Am J Physiol Ren Physiol, 2020, 319(5): F782-F791. doi:10.1152/ajprenal. 00438.2020 .
[11] DUERING M, BIESSELS G J, BRODTMANN A, et al. Neuroimaging standards for research into small vessel disease—advances since 2013[J]. Lancet Neurol, 2023, 22(7): 602-618. doi:10.1016/S1474-4422(23)00131-X .
[12] 郭一丹, 崔玮, 叶鹏鹏, 等. 中老年维持性血液透析患者透析过程中脑血流量变化[J]. 中华肾脏病杂志, 2024, 40(10): 792-797. doi:10.3760/cma.j.cn441217-20240208-00214 .
[13] ZHENG K, ZHOU Y, QIAN Y, et al. Increased premature cerebral small vessel diseases in dialysis patients: A retrospective cross-sectional study[J]. Nephron, 2021, 145(4): 330-341. doi:10.1159/000513121 .
[14] 中华医学会放射学分会神经学组. 脑小血管病MRI规范化应用专家共识[J]. 中华放射学杂志, 2024, 58(1): 6-17. doi:10.3760/cma.j.cn112149-20231031-00334 .
[15] PRADEEP A, RAGHAVAN S, PRZYBELSKI S A, et al. Can white matter hyperintensities based Fazekas visual assessment scales inform about Alzheimer’s disease pathology in the population?[J]. Alzheimers Res Ther, 2024, 16(1): 157. doi:10.1186/s13195-024-01525-5 .
[16] ROSEBOROUGH A D, SAAD L, GOODMAN M, et al. White matter hyperintensities and longitudinal cognitive decline in cognitively normal populations and across diagnostic categories: A meta-analysis, systematic review, and recommendations for future study harmonization[J]. Alzheimers Dement, 2023, 19(1): 194-207. doi:10.1002/alz.12642 .
[17] 邓小莹, 范永祥, 莫志铭, 等. 脑白质高信号患者血浆脂蛋白磷脂酶A2水平及其与认知功能障碍的关系[J]. 实用医学杂志, 2021, 37(7): 884-888. doi:10.3969/j.issn.1006-5725.2021.07.011 .
[18] 赵红, 李潇, 王翠. 关注少突胶质细胞: 阿尔茨海默病治疗的新靶点[J]. 实用医学杂志, 2023, 39(13): 1595-1599. doi:10.3969/j.issn.1006-5725.2023.13.001 .
[19] VAN VELUW S J, ARFANAKIS K, SCHNEIDER J A. Neuropathology of vascular brain health: Insights from ex vivo magnetic resonance imaging-histopathology studies in cerebral small vessel disease[J]. Stroke, 2022, 53(2): 404-415. doi:10.1161/strokeaha.121.032608 .
[20] 郭晓云, 李芳瑜, 李文君, 等. 脑白质病变与脑血流动力学指标的相关性分析[J]. 河北医科大学学报, 2025, 46(9): 1004-1011. doi:10.3969/j.issn.1007-3205.2025.09.003 .
[21] ZHANG D, ZHANG J, ZHANG B, et al. Association of blood pressure, white matter lesions, and regional cerebral blood flow[J]. Med Sci Monit, 2021, 27: e929958. doi:10.12659/msm. 929958 .
[22] POLINDER-BOS H A, GARCíA D V, KUIPERS J, et al. Hemodialysis induces an acute decline in cerebral blood flow in elderly patients[J]. J Am Soc Nephrol, 2018, 29(4): 1317-1325. doi:10.1681/asn.2017101088 .
[23] FINDLAY M D, DAWSON J, DICKIE D A, et al. Investigating the relationship between cerebral blood flow and cognitive function in hemodialysis patients[J]. J Am Soc Nephrol, 2019, 30(1): 147-158. doi:10.1681/asn.2018050462 .
[24] LI M, YANG W, SONG L, et al. Association between white matter hyperintensities and altered cerebral blood flow in maintenance hemodialysis patients: A longitudinal study[J]. BMC Nephrol, 2024, 25(1): 33. doi:10.1186/s12882-024-03468-3 .
[25] KANG P, YING C, CHEN Y, et al. Oxygen metabolic stress and white matter injury in patients with cerebral small vessel disease[J]. Stroke, 2022, 53(5): 1570-1579. doi:10.1161/strokeaha. 121.035674 .
[26] SMIRNOV M, DESTRIEUX C, MALDONADO I L. Cerebral white matter vasculature: Still uncharted?[J]. Brain, 2021, 144(12): 3561-3575. doi:10.1093/brain/awab273 .
[27] XIE D, LIU H, XU F, et al. IL33 (interleukin 33)/ST2 (interleukin 1 receptor-like 1) axis drives protective microglial responses and promotes white matter integrity after stroke[J]. Stroke, 2021, 52(6): 2150-2161. doi:10.1161/strokeaha.120. 032444 .
[28] GAO Y, LI D, LIN J, et al. Cerebral small vessel disease: Pathological mechanisms and potential therapeutic targets[J]. Front Aging Neurosci, 2022, 14: 961661. doi:10.3389/fnagi.2022. 961661 .
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