Sleep disturbances are common in
end-stage renal disease (
ESRD) patients. However, the underlying neuropathological mechanisms are largely unclear. Previous studies have revealed the important role of the thalamus in the potential mechanisms of
sleep disorders. We hypothesized that the sleep disturbances in
ESRD patients may correspond to metabolic changes of thalamus and the uremic factors may have a vital contribution on these changes. We performed multi-voxel 1H-MRS of bilateral thalami in 27
ESRD patients who currently receiving
hemodialysis treatment and 21 age-matched healthy volunteers.
ESRD patients underwent Pittsburgh Sleep Quality Index (PSQI) scale and
restless legs syndrome (RLS) rating scale assessment. Laboratory blood tests including serum
creatinine, serum
urea,
cystatin-C, serum
parathyroid hormone (PTH),
calcium and
phosphorus levels,
hemoglobin and hematocrit were performed in all
ESRD patients close to the time of the MR examination. We found correlations among elevated PTH, higher PSQI score and RLS rating score in
ESRD patients.
ESRD patients displayed decreased
N-acetylaspartate and
creatine ratio (NAA/Cr) of thalami compared with controls. There were significantly negative correlation between NAA/Cr and serum PTH level or PSQI score. The metabolic changes of thalami played an important role in the neuropathological mechanisms of lower sleep quality in
ESRD patients.
Secondary hyperparathyroidism as one of the main
uremia-related factors was closely related to abnormal metabolites of the thalamus in patients with
ESRD, revealing the crosstalk procedure between renal impairment and brain function.