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  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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More rapid progression of brain atrophy in patients on peritoneal dialysis compared with hemodialysis: The VCOHP Study

A Comment to this article was published on 05 January 2024


We previously reported that brain atrophy was more severe and progressed more rapidly in patients with end-stage kidney disease on peritoneal dialysis (PD) than those with non-dialysis-dependent chronic kidney disease. However, it remains unknown whether there is a difference between patients on PD and hemodialysis (HD). In total, 73 PD and 34 HD patients who underwent brain magnetic resonance imaging (MRI) were recruited for a cross-sectional analysis. Among them, 42 PD and 25 HD patients who underwent a second brain MRI after 2 years were recruited for a longitudinal analysis. T1-weighted MRI images were analyzed. Total gray matter volume (GMV), total white matter volume, and cerebrospinal fluid volume were segmented, and each volume was quantified using statistical parametric mapping software. The ratio of GMV (GMR) was calculated by dividing GMV by intracranial volume, to adjust for variations in head size. We compared GMR between PD and HD patients in the cross-sectional analysis and the annual change in GMR (AC-GMR) in the longitudinal analysis. In the cross-sectional analysis, age- and sex-adjusted GMR was significantly lower in PD than HD patients [least square mean (LSM): 39.2% vs. 40.0%, P = 0.018]. AC-GMR was significantly greater in PD than HD patients and this difference remained significant even after adjustment for potential confounding factors (LSM: −0.68 vs. −0.28 percentage-points/year, P = 0.011). In conclusion, the present study demonstrated a more rapid progression of brain atrophy in PD patients compared with HD patients.

We demonstrated that decline in GMR progressed significantly more rapidly in PD than HD patients independent of potential confounding factors. GMR gray matter volume ratio, HD hemodialysis, PD peritoneal dialysis.

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We greatly appreciate Prof. Takashi Yoshiura (Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences) for technical advice on the analysis of the MRI data and the staff of the Advanced Preventive Medical Center in Kyushu University Hospital for their kind cooperation. We also appreciate Drs. Koji Mitsuiki (Harasanshin Hospital), Hideki Hirakata (Fukuoka Renal Clinic), Takashi Nagae (National Hospital Organization Fukuoka-higashi Medical Center), Masatomo Taniguchi (Fukuoka Renal Clinic), Yasuhiro Kawai (Steel Memorial Yawata Hospital), Yasuhisa Tamura (JCHO Kyushu Hospital), Michiya Shinozaki (Shin-Yurigaoka General Hospital), Hidetoshi Kanai (Kokura Memorial Hospital), Takashi Deguchi (Hamanomachi Hospital), Dai Matsuo (Munakata Medical Association Hospital), Izumi Shimano (Munakata Medical Association Hospital), Yusuke Kuroki (National Hospital Organization Fukuoka-higashi Medical Center), Itsuko Ishida (Gofukumachi Kidney Clinic, Harasanshin Hospital), Kei Hori (Hori Clinic), Shotaro Ohnaka (Tagawa Municipal Hospital), Hiroshi Tsuruta (Kokura Daiichi Hospital), Toru Mizumasa (Kyushu Central Hospital), Makoto Hirakawa (Hirakawa Internal Medicine Clinic), Takahiro Yoshimitsu (Fukuoka Mirai Hospital), Kiyoshi Ikeda (Ikeda Vascular Access Dialysis and Internal Medicine Clinic), Koichiro Goto (Goto Clinic), Chiaki Miishima (Miishima Internal Medicine Clinic), Kiichiro Ueno (Ueno Hospital), Takashi Ono (Toma Clinic), Toru Sanai (Fukumitsu Clinic), Takashi Ando (Hakozaki Park Internal Medicine Clinic) for their helpful enrollment of patients to this study. We thank Richard Robins, PhD, from Edanz Group ( for editing a draft of this manuscript.


This work was not financially supported by any pharmaceutical company or funding agency.

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Study conception and design: KaT, HY; data acquisition: KaT, HY, SY, NH, ST, AT, ME, KF, KuT, TN, KM; data analysis/interpretation: KaT, HY; statistical analysis: KaT, HY; supervision or mentorship: TK. Each author made important intellectual contributions during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. KaT takes responsibility that this study has been reported honestly, accurately, and transparently; that no important aspects of the study have been omitted, and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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Correspondence to Kazuhiko Tsuruya.

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Tsuruya, K., Yoshida, H., Yamada, S. et al. More rapid progression of brain atrophy in patients on peritoneal dialysis compared with hemodialysis: The VCOHP Study. Hypertens Res 47, 887–897 (2024).

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