{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:05:11Z","timestamp":1789707911005,"version":"4.0.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peak width of skeletonized mean diffusivity (PSMD) is a diffusion tensor imaging-based marker of diffuse white matter microstructural injury that has been associated with cerebral small vessel disease (CSVD). This study aimed to investigate whether patients with end-stage kidney disease (ESKD) exhibit altered PSMD compared with healthy controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively enrolled 38 ESKD patients and 38 age- and sex-matched healthy controls. Diffusion tensor imaging (DTI) was performed using a three-tesla MRI scanner in patients with ESKD and healthy controls. We obtained PSMD based on DTI in several steps, including preprocessing, skeletonization, application of a custom mask, and histogram analysis. We compared PSMD between the groups and performed correlation analyses between PSMD and clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PSMD was higher in patients with ESKD than in healthy controls (2.945\u202f\u00b1\u202f0.361 vs. 2.552\u202f\u00b1\u202f0.458\u202f\u00d7\u202f10\n                      <jats:sup>\u22124<\/jats:sup>\n                      mm\n                      <jats:sup>2<\/jats:sup>\n                      \/s,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). In addition, PSMD positively correlated with age (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.370,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.022). In exploratory subgroup analyses, no statistically significant differences in PSMD were observed according to dialysis modality or the presence of diabetes mellitus.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We demonstrated that patients with ESKD exhibited higher PSMD than healthy controls, suggesting diffuse white matter microstructural injury that may be related to CSVD. PSMD may be a useful imaging marker for characterizing diffuse white matter abnormalities in this population, although further studies incorporating conventional CSVD markers, vascular risk\u2013matched controls, and clinical outcome measures are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1877913","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:31:11Z","timestamp":1789705871000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Elevated peak width of skeletonized mean diffusivity in patients with end-stage kidney disease: evidence of diffuse white matter microstructural injury"],"prefix":"10.3389","volume":"17","author":[{"given":"Junghae","family":"Ko","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University","place":["Busan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bong Soo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University","place":["Busan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Min","family":"Heo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University","place":["Busan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sihyung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University","place":["Busan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyae","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University","place":["Busan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho-Joon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology, Haeundae Paik Hospital, College of Medicine, Inje University","place":["Busan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Ah","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Haeundae Paik Hospital, College of Medicine, Inje University","place":["Busan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang Min","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurology, Haeundae Paik Hospital, College of Medicine, Inje University","place":["Busan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2089","DOI":"10.1111\/j.1523-1755.2005.00365.x","article-title":"Definition and classification of chronic kidney disease: a position statement from kidney disease: improving global outcomes (KDIGO)","volume":"67","author":"Levey","year":"2005","journal-title":"Kidney Int"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"31","DOI":"10.5853\/jos.2015.17.1.31","article-title":"Cerebral small vessel disease and chronic kidney disease","volume":"17","author":"Toyoda","year":"2015","journal-title":"J Stroke"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/s1474-4422(14)70026-2","article-title":"Stroke and cerebrovascular diseases in patients with chronic kidney disease","volume":"13","author":"Toyoda","year":"2014","journal-title":"Lancet Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1093\/ndt\/gfv009","article-title":"Chronic kidney disease and the risk of stroke: a systematic review and meta-analysis","volume":"30","author":"Masson","year":"2015","journal-title":"Nephrol. 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