Small-Vessel Disease in Patients with ESKD Evidenced by Elevated Peak Width of Skeletonized Mean Diffusivity

Background: The peak width of skeletonized mean diffusivity (PSMD) is a novel marker for small vessel disease. The aim of this study was to investigate the small vessel disease in patients with end-stage renal disease (ESRD) using PSMD. Methods: We prospectively enrolled patients with ESRD, and also included age and sex-matched healthy controls. Diffusion tensor imaging (DTI) was performed using the three tesla MRI scanner in patients with ESRD and healthy controls. We obtained the PSMD based on the DTI by several steps including preprocessing, skeletonization, application of a custom mask, and histogram analysis. We compared the PSMD between the groups, and also performed correlation analysis between PSMD and clinical factors. Results: We enrolled the 38 patients with ESRD and 38 healthy controls. There was significant difference of the PSMD between the patients with ESRD and healthy controls. The PSMD was higher in the patients with ESRD than that in the healthy control group (2.945 vs. 2.552×10-4 mm2/s, p<0.001, Fig 1). In addition, the PSMD was positively correlated with age (r=0.370, p=0.022). However, PSMD did not differ depending on the types of dialysis or presence of diabetes mellitus. Conclusion: We demonstrate that patients with ESRD exhibit higher PSMD compared to healthy controls, indicating greater small vessel disease. The findings provide crucial information for clinical management and treatment strategies, highlighting the importance of addressing small vessel disease in patients with ESRD.Figure 1. Difference in the PSMD between patients with ESRD and healthy controls