Choroid plexus volume mediates glymphatic and executive dysfunction in end-stage renal disease patients with mild cognitive impairment

Motivation: Mild cognitive impairment (MCI) is prevalent in end-stage renal disease (ESRD), potentially due to glymphatic dysfunction impacting waste clearance. Goal(s): This study aims to investigate glymphatic function in ESRD-MCI patients by assessing choroid plexus volume (CPV) and diffusion tensor imaging along the perivascular space (DTI-ALPS) index. Approach: We compared cognitive performance, CPV and DTI-ALPS index between ESRD-MCI and healthy controls (HC). Employing mediation analysis to examine CPV's role in linking glymphatic dysfunction to MCI. Results: ESRD-MCI showed significantly lower DTI-ALPS index and higher CPV than HC. CPV mediated the relationships between ESRD status, reduced DTI-ALPS index, and executive dysfunction. Impact: This study identifies choroid plexus volume as a potential mediator of glymphatic dysfunction and executive dysfunction in ESRD-MCI, suggesting its role in cognitive impairment pathophysiology. This finding offers a target for interventions to address cognitive decline in ESRD patients.