Progression of cerebral small vessel disease in maintenance hemodialysis patients: a prospective cohort study

Background Cerebral small vessel disease (CSVD) is a major vascular contributor to dementia, cognitive decline, gait impairment, mood disturbance and stroke. Maintenance hemodialysis (MHD) patients have a high CSVD prevalence with poor prognosis. However, the dynamic progressive features and associated risk factors of CSVD in MHD patients remain unclear. We aimed to explore the progression of CSVD subtypes and their associated risk factors in MHD patients. Method This prospective cohort study enrolled MHD patients from January to June 2023 at Beijing Shijitan Hospital. Clinical and dialysis-related data were collected. Transcranial Doppler (TCD) was used to monitor the mean flow velocity (MFV) of the middle cerebral artery during dialysis, and the MFV reduction rate during dialysis was calculated. The cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and Lacunes on brain magnetic resonance imaging (MRI) were assessed at baseline and at the 12-month follow-up. Multivariate linear regression model was used to analyze the risk factors associated with the progression of CSVD. Results A total of 92 MHD patients were included in this study, with a mean age of (63.21 ± 8.21) years (40–85 years old) and 71 males (77.17%). Compared with baseline, significant progression was observed in CMBs, WMHs and Lacunes at the 12-month follow-up ( p  < 0.05). Multivariate linear regression analysis showed that longer dialysis vintage, higher MVF reduction rate, and elevated hsCRP levels were significantly associated with CMBs progression ( B  = 0.065, 95% CI : 0.021–0.109, p  = 0.004; B  = 19.274, 95% CI : 0.379–38.168, p  = 0.046; B  = 0.311, 95% CI : 0.068–0.554, p  = 0.013). Aging and increased MVF reduction rate were associated with WMHs progression ( B  = 0.023, 95% CI : 0.006–0.040, p  = 0.010; B  = 1.352, 95% CI : 0.156–1.636, p  = 0.013). In addition, smoking status and diabetes mellitus were significantly linked to lacunars progression ( B  = 0.896, 95% CI : 0.156–1.636, p  = 0.018; B  = 1.230, 95% CI : 0.414–2.045, p  = 0.004). Conclusion In addition to age, dialysis vintage, diabetes mellitus and smoking, the reduction in cerebral blood flow during hemodialysis is an independent risk factor for the progression of CSVD in MHD patients.