PMC6219271_01
Images from the magnetic resonance imaging at the hemodialysis initiation.. Notes: Left, coronal; middle, axial; right, sagittal.
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The cranial magnetic resonance imaging (MRI; Figure 2) was performed 3 days before the hemodialysis initiation.
The SUVRWCb image from the surface projection of PiB/PET.. Notes: Top, visit 1 (at the hemodialysis initiation); middle, visit 2 (6 months after the hemodialysis initiation); bottom, visit 3 (12 months after the hemodialysis initiation).. Abbreviations: PiB/PET, positron emission tomography with Pittsburgh compound B as probe; SUVRWCb, standard uptake value ratio with whole cerebellum as reference.
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True V (Siemens Healthineers, Erlangen, Germany), as reported previously. PiB images were visually rated as PiB-positive or PiB-negative, as described previously. The first PiB/PET was performed 14 days after the hemodialysis initiation (Figure 3, top), which showed a PiB-positive result. After the patient received maintenance hemodialysis (4 h/day, 3 days/week) for 6 months (visit 2), PiB/PET was performed again. After 6-month hemodialysis, the Abeta accumulation in the brain was decreased (Figure 3, middle). On visit 3, PiB/PET was performed again after maintenance hemodialysis of 12 months (Figure 3, bottom).
The concentration change of Abetas in the blood and MMSE score after the hemodialysis initiation.. Notes: The left vertical axis represents Abeta1-42 (pg/mL), Abeta oligomers (pmol/L), Abeta1-42:Abeta1-40 ratio (x100), MMSE scores, beta2MG (mg/L), and creatinine (mg/dL). The right vertical axis represents Abeta1-40 (pg/mL). Black arrows indicate the day of PiB/PET. The horizontal axis represents days from the hemodialysis initiation. The blood samples were collected just before the start of each hemodialysis session for the period after the hemodialysis initiation.. Abbreviations: Abeta, amyloid-beta; beta2MG, beta2-microglobulin; MMSE, Mini-Mental State Examination; PiB/PET, positron emission tomography with Pittsburgh compound B as probe.
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Regarding cognitive functions, MMSE scores were the lowest at 23 points at the hemodialysis initiation but gradually increased during 3 months of maintenance hemodialysis (Figure 4). Then, the scores marginally increased (improved) and were maintained at 26 points after 194 and 285 days of the hemodialysis initiation, and at 27 points after 355, 453, and 719 days (the last data are not shown in Figure 4). Abeta monomers and oligomers in the plasma, as described previously (Figure 4). II (WAKO Pure Chemical, Osaka, Japan), were as high as 971 and 73.7 pg/mL, respectively, because of renal failure. After the hemodialysis initiation, both plasma Abeta1-40 and Abeta1-42 concentrations decreased for around 6 months, but then increased and were maintained as 709-1,033 and 77.2-99.2 pg/mL, respectively. In addition, the ratios of Abeta1-40 to Abeta1-42 were 0.077 (Day 3; Figure 4) and 0.076 (Day 0) just before the hemodialysis initiation. However, the ratios increased up to 0.117 for 6 months after hemodialysis initiation, but then were maintained between 0.08 and 0.10 (Figure 4). Contrary to Abeta monomers, the concentrations of Abeta oligomers in the plasma, measured with Human Amyloid beta Oligomers (82E1-specific) Assay Kit (IBL, Fujioka, Japan), were below the detection limit (0; Figure 4) at the hemodialysis initiation and were maintained at 0 for 194 days after hemodialysis initiation. Then, plasma Abeta oligomer concentrations increased to 13.6-33.8 pmol/L after 285 days of the hemodialysis initiation (Figure 4). Serum Cr and beta2-microglobulin (beta2MG) concentrations just before hemodialysis sessions are shown in Figure 4 (measured by clinical test companies such as SRL, Nagoya, Japan).