Increased Brain white matter extracellular free-water is associated with memory function in ESRD patients

Motivation: White matter changes in hemodialysis patients that may arise from neuroinflammation, microvascular damage, or extracellular fluid accumulation. Goal(s): This study aimed to investigate white matter microstructural alterations and extracellular free water (FW) volume, and their relationship with neurocognitive function in hemodialysis patients. Approach: FW imaging was used to assess WM microstructure and FW volume in hemodialysis patients compared to healthy controls, examining correlations with cognitive performance. Results: Hemodialysis patients showed increased extracellular FW in WM, particularly in projection, callosal, and association fibers, which correlated with poorer memory performance on Trials 1-5. Impact: This study highlights a potential link between elevated extracellular free water in white matter and memory decline in hemodialysis patients, suggesting neuroinflammation or microvascular impairment. These findings could inform future research on neuroprotective strategies in dialysis patients.