Neurovascular decoupling is associated with altered glymphatic function as assessed by the DTI-ALPS index in patients on dialysis

Abstract

Neurovascular coupling (NVC) reflects the coordination between brain activity and cerebral blood flow, while glymphatic function indicates the capacity to clear metabolic waste from the brain. However, differences in these two factors between patients on peritoneal dialysis (PD) and hemodialysis (HD), as well as their interrelationship, remain unclear. Functional magnetic resonance imaging, three-dimensional pseudo-continuous arterial spin labeling, and diffusion tensor imaging were prospectively performed in 56 patients on PD, 54 patients on HD, and 52 healthy controls (HC). The study calculated the amplitude of low frequency fluctuation-cerebral blood flow (ALFF-CBF) coupling coefficient and the diffusion tensor image analysis along the perivascular space (DTI-ALPS) index, which respectively represent the overall NVC level and the glymphatic function. Compared to HC, patients on PD and HD exhibited lower ALFF-CBF coupling coefficients and DTI-ALPS indices, but there were no significant differences between the PD and HD groups. Additionally, positive correlations were observed between ALFF-CBF coupling coefficients and DTI-ALPS indices across all three groups. he degrees of neurovascular decoupling and altered glymphatic function are comparable between patients on PD and HD. Importantly, neurovascular decoupling may be associated with altered glymphatic function in patients on dialysis. The degrees of neurovascular decoupling and altered glymphatic function are comparable between patients on PD and HD. Importantly, neurovascular decoupling may be associated with altered glymphatic function in patients on dialysis.

Keywords: Cognitive impairment; Glymphatic function; Hemodialysis; Neurovascular coupling; Peritoneal dialysis.