# Horizontal analysis and longitudinal cohort study of chronic renal failure correlates and cerebral small vessel disease relationship using peak width of skeletonized mean diffusivity

## TL;DR

This study explores how a brain MRI biomarker called PSMD relates to kidney function decline in patients with chronic renal failure.

## Contribution

The paper introduces PSMD as a novel MRI biomarker to assess the relationship between cerebral small vessel disease and chronic renal failure progression.

## Key findings

- PSMD increased significantly in progressive chronic renal failure patients over time.
- PSMD showed a strong correlation with estimated glomerular filtration rate (eGFR).
- Changes in PSMD (ΔPSMD) improved classification of progressive versus stable chronic renal failure groups.

## Abstract

Peak width of skeletonized mean diffusivity (PSMD) is an MRI-based biomarker that may reflect white matter lesions (WML). PSMD is based on skeletonization of MR DTI data and histogram analysis. Both chronic renal failure (CRF) and WML may be affected by multisystemic small-vessel disorder. We aimed to explore the relationship between PSMD and estimated glomerular filtration rate (eGFR).

Fifty followed-up CRF patients matched for age, sex, hypertension and smoking status were enrolled and classified into a progressive group (n = 16) and stable group (n = 34) based on eGFR levels. Longitudinal and horizontal differences of PSMD were compared between the progressive and stable groups at the initial and follow-up time points. Pearson’s correlation was used for correlation of eGFR with PSMD and WML (per Fazekas scale score). ROC was used to measure the sensitivity of PSMD and WML score to changes of eGFR.

At the follow-up time point, PSMD of the progressive group was significantly higher than at the initial time point (p < 0.001), and PSMD of the progressive group was significantly higher than stable group (p < 0.001). PSMD and eGFR were significantly correlated. AUC curves explored that ΔPSMD (PSMD changes at the follow-up and initial time points) and follow-up PSMD was better for the classification of progressive and stable groups.

PSMD has significant correlation with eGFR, PSMD can reveal a close relationship between WML and CRF.