Glymphatic system dysfunction in nondialysis-dependent ESRD patients with diabetic kidney disease: associations with clinical characteristics and cognitive function.

Objectives: To investigate glymphatic function in nondialysis-dependent ESRD (ND-ESRD) patients with diabetic kidney disease (DKD) or non-DKD using the diffusion tensor image analysis along the perivascular space (DTI-ALPS) method and choroid plexus (CP) volume to explore the associations among DTI-ALPS index, CP volume, clinical characteristics, and cognitive function.

Methods: 25 DKD patients, 25 non-DKD patients, and 25 healthy control (HC) were included in this study. All participants underwent cerebral MRI and cognitive assessments. Bilateral DTI-ALPS index and CP volume were calculated and were compared among three groups. Correlations among the DTI-ALPS index, CP volume, clinical characteristics, and cognitive function were analyzed.

Results: DKD patients had significantly lower left DTI-ALPS index ( = 0.001) and mean DTI-ALPS index ( = 0.003) than non-DKD patients. In ND-ESRD patients, there was a significant positive correlation between the left DTI-ALPS index and phosphorus ( = 0.377,  = 0.007) and attention score ( = 0.434,  = 0.002). In DKD group, the mean DTI-ALPS was positively correlated with total cholesterol ( = 0.631,  = 0.001). In non-DKD group, there was a significant positive correlation between the left DTI-ALPS index and phosphorus ( = 0.696,  < 0.001). Both DKD and non-DKD patients exhibited significant higher CP volume than HC group. In non-DKD group, CP volume was negatively correlated with mean DTI-ALPS (r = -0.535,  = 0.006) and attention score of MoCA (r = -0.538,  = 0.006).

Conclusions: Glymphatic system dysfunction may contribute to the pathogenesis of clinical and cognitive impairment in ND-ESRD patients especially with DKD.