{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:37:10Z","timestamp":1787960230576,"version":"build-2784847793"},"reference-count":61,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","funder":[{"name":"Forrest and Sally Hoglund"},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["S10 RR29577"],"award-info":[{"award-number":["S10 RR29577"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23 AG055666"],"award-info":[{"award-number":["K23 AG055666"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R21 AG061549"],"award-info":[{"award-number":["R21 AG061549"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30 AG035982"],"award-info":[{"award-number":["P30 AG035982"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1 TR002366"],"award-info":[{"award-number":["UL1 TR002366"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30 DK106912"],"award-info":[{"award-number":["P30 DK106912"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Kansas Medical Center Jared Grantham Kidney Institute","award":["Pilot Grant"],"award-info":[{"award-number":["Pilot Grant"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>Kidney disease is accompanied by structural and physiologic brain abnormalities and increased risk of dementia and stroke. Because RRT with dialysis does not normalize these brain abnormalities, the authors evaluated the possible benefit of kidney transplantation. Using magnetic resonance imaging methods to measure brain abnormalities before and after kidney transplantation, they demonstrated that this intervention normalizes cerebral blood flow, neurochemical concentrations, and white matter integrity. They also found that these changes persist beyond the initial post-transplantation period and thus, cannot be attributed to periprocedural interventions, such as steroids. Their findings suggest that brain abnormalities in kidney disease may be reversible. Further studies are needed to understand the mechanisms underlying these brain abnormalities and to explore interventions to prevent and mitigate them in patients who cannot undergo kidney transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>CKD is associated with abnormalities in cerebral blood flow, cerebral neurochemical concentrations, and white matter integrity. Each of these is associated with adverse clinical consequences in the non-CKD population, which may explain the high prevalence of dementia and stroke in ESKD. Because cognition improves after kidney transplantation, comparing these brain abnormalities before and after kidney transplantation may identify potential reversibility in ESKD-associated brain abnormalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this study of patients with ESKD and age-matched healthy controls, we used arterial spin labeling to assess the effects of kidney transplantation on cerebral blood flow and magnetic resonance spectroscopic imaging to measure cerebral neurochemical concentrations (\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      -acetylaspartate, choline, glutamate, glutamine, myo-inositol, and total creatine). We also assessed white matter integrity measured by fractional anisotropy (FA) and mean diffusivity (MD) with diffusion tensor imaging. We used a linear mixed model analysis to compare longitudinal, repeated brain magnetic resonance imaging measurements before, 3 months after, and 12 months after transplantation and compared these findings with those of healthy controls.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Study participants included 29 patients with ESKD and 19 controls; 22 patients completed post-transplant magnetic resonance imaging. Cerebral blood flow, which was higher in patients pretransplant compared with controls (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.003), decreased post-transplant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) to values in controls. Concentrations of neurochemicals choline and myo-inositol that were higher pretransplant compared with controls (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001, respectively) also normalized post-transplant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001, respectively). FA increased (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001) and MD decreased (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) post-transplant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Certain brain abnormalities in CKD are reversible and normalize with kidney transplantation. Further studies are needed to understand the mechanisms underlying these brain abnormalities and to explore interventions to mitigate them even in patients who cannot be transplanted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial registry name and registration number:<\/jats:title>\n                    <jats:p>Cognitive Impairment and Imaging Correlates in End Stage Renal Disease, NCT01883349<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1681\/asn.2020050584","type":"journal-article","created":{"date-parts":[[2020,10,16]],"date-time":"2020-10-16T19:11:00Z","timestamp":1602875460000},"page":"177-187","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":40,"title":["Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation"],"prefix":"10.1681","volume":"32","clinical-trial-number":[{"clinical-trial-number":"nct01883349","registry":"10.18810\/clinical-trials-gov","type":"results"},{"clinical-trial-number":"nct01883349","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9269-051X","authenticated-orcid":false,"given":"Rebecca J.","family":"Lepping","sequence":"first","affiliation":[{"name":"Hoglund Biomedical Imaging Center, Kansas City, Kansas"},{"name":"University of Kansas Alzheimer\u2019s Disease Center, Fairway, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert N.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Palash","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Mahnken","sequence":"additional","affiliation":[{"name":"University of Kansas Alzheimer\u2019s Disease Center, Fairway, Kansas"},{"name":"Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5181-7131","authenticated-orcid":false,"given":"Eric D.","family":"Vidoni","sequence":"additional","affiliation":[{"name":"University of Kansas Alzheimer\u2019s Disease Center, Fairway, Kansas"},{"name":"Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In-Young","family":"Choi","sequence":"additional","affiliation":[{"name":"Hoglund Biomedical Imaging Center, Kansas City, Kansas"},{"name":"Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4927-6609","authenticated-orcid":false,"given":"Mark J.","family":"Sarnak","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M.","family":"Brooks","sequence":"additional","affiliation":[{"name":"Hoglund Biomedical Imaging Center, Kansas City, Kansas"},{"name":"University of Kansas Alzheimer\u2019s Disease Center, Fairway, Kansas"},{"name":"Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas"},{"name":"Frontiers: University of Kanas Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Burns","sequence":"additional","affiliation":[{"name":"University of Kansas Alzheimer\u2019s Disease Center, Fairway, Kansas"},{"name":"Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas"},{"name":"Frontiers: University of Kanas Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6286-802X","authenticated-orcid":false,"given":"Aditi","family":"Gupta","sequence":"additional","affiliation":[{"name":"University of Kansas Alzheimer\u2019s Disease Center, Fairway, Kansas"},{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas"},{"name":"The Kidney Institute, University of Kansas Medical Center, Kansas City, 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