Association between abnormal thalamic metabolites and sleep disturbance in patients with end-stage renal disease
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Sleep disturbances are common in end-stage renal disease (ESRD) patients. However, the underlying neuropathological mechanisms are largely unclear. Previous studies have revealed the important role of the thalamus in the potential mechanisms of sleep disorders. We hypothesized that the sleep disturbances in ESRD patients may correspond to metabolic changes of thalamus and the uremic factors may have a vital contribution on these changes. We performed multi-voxel 1H-MRS of bilateral thalami in 27 ESRD patients who currently receiving hemodialysis treatment and 21 age-matched healthy volunteers. ESRD patients underwent Pittsburgh Sleep Quality Index (PSQI) scale and restless legs syndrome (RLS) rating scale assessment. Laboratory blood tests including serum creatinine, serum urea, cystatin-C, serum parathyroid hormone (PTH), calcium and phosphorus levels, hemoglobin and hematocrit were performed in all ESRD patients close to the time of the MR examination. We found correlations among elevated PTH, higher PSQI score and RLS rating score in ESRD patients. ESRD patients displayed decreased N-acetylaspartate and creatine ratio (NAA/Cr) of thalami compared with controls. There were significantly negative correlation between NAA/Cr and serum PTH level or PSQI score. The metabolic changes of thalami played an important role in the neuropathological mechanisms of lower sleep quality in ESRD patients. Secondary hyperparathyroidism as one of the main uremia-related factors was closely related to abnormal metabolites of the thalamus in patients with ESRD, revealing the crosstalk procedure between renal impairment and brain function.
KeywordsEnd-stage renal disease Magnetic resonance spectroscopy Sleep quality Metabolites Thalamus
Ming Zhang and Ji-xin Liu were responsible for the design and study concept. Xue-ying Ma, Yan Zhang, Shao-hui Ma contributed to the data acquisition. Xue-ying Ma, Yan Zhang, Shaohui Ma, Peng Li and Dun Ding contributed to the data analysis and interpretation of findings. Xue-ying Ma drafted the manuscript. Ji-xin Liu and Ming Zhang revised the manuscript. Xue-ying Ma and Yan Zhang contributed equally to this work. All authors critically reviewed the manuscript and approved the final version for publication. This research was supported by the National Natural Science Foundation of China (Grant No. 81371530, 81571640 and 81471737) and Natural Science Foundation of Shaanxi Province of China (Grant No. 2017ZDJC-13).
This research was supported by the National Natural Science Foundation of China (Grant No. 81371530 and 81571640) and Natural Science Foundation of Shaanxi Province of China (Grant No. 2017ZDJC-13).
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Conflict of interest
The authors disclose no conflicts.
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