DIALYSIS AND TRANSPLANTATION AFFECT CEREBRAL ABNORMALITIES OF END-STAGE RENAL-DISEASE

Localized short echo time proton magnetic resonance spectroscopy was p erformed to determine whether chronic and end-stage renal failure, hem odialysis, continuous ambulatory peritoneal dialysis, or renal transpl antation result in alterations of cerebral water and metabolites in hu mans, Hemodialysis patients show an increased cerebral concentration o f myo-inositol (+ 14%; P < .05), Increased metabolite ratios are found for myo-inositol/creatine (+ 14%; P < .01) and choline-containing com pounds choline/creatine (+ 10%; P < .01) and are more marked in gray t han in white matter. N-acetylaspartate and total creatine concentratio ns are unaffected, Compared to hemodialysis, continuous ambulatory per itoneal dialysis patients show a larger increase in choline and less e levated myo-inositol, Acutely, hemodialysis significantly decreases th e cerebrospinal fluid content of the examined brain regions, but metab olite changes are small compared to the persistent alterations in pati ents receiving hemodialysis or continuous ambulatory peritoneal dialys is, Undialyzed patients with chronic renal failure do not differ from patients on hemodialysis, but cerebral metabolite changes are complete ly reversed by transplantation. Cerebral metabolic effects of end-stag e renal disease differ from Alzheimer's disease, which is associated w ith markedly reduced N-acetylaspartate, increased myo-inositol, and no rmal choline concentrations. The small but significant cerebral metabo lic disorders associated with renal failure and dialysis may be a cons equence of osmotic dysregulation.