Hemodialysis may interfere with blood flow to the brain and lead to white matter injury, according to investigators.

Christopher W. McIntyre, MBBS, DM, of Victoria Hospital in London, Ontario, Canada, and colleagues studied 17 patients (mean age 63 years; 58.8% male) during a single hemodialysis session using anatomical magnetic resonance imaging (MRI), diffusion tensor imaging, and proton magnetic resonance spectroscopy. They performed brain imaging before the hemodialysis session and within the last 60 minutes of dialysis during maximal circulatory stress.

Imaging results showed intradialytic changes in brain tissue volume, diffusion metrics, and brain metabolite concentrations “consistent with ischemic injury,” the investigators reported in the Journal of the American Society of Nephrology. They observed decreases in N-acetyl aspartate and choline, indicating regional ischemia. Based on prior stroke literature, they suspected that ischemia may lead to cytotoxic edema.

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“This raises the possibility that the repeated delivery of [hemodialysis] could have an impact on long-term structural brain injury and cognitive function,” according to Dr McIntyre’s team. “Preventing brain injury and preserving cognitive vitality should begin to be seen as a primary responsibility for physicians and agencies providing care to [hemodialysis] patients.”

Due to the small sample size of the study, results should be considered preliminary. The investigators were unable to directly measure blood flow or shifts in sodium and urea in the brain. Further research is needed to establish whether hemodialysis has long-term neurologic consequences such as cognitive impairment.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Anazodo UC, Wong DY, Théberge J, et al. Hemodialysis-related acute brain injury demonstrated by application of intradialytic magnetic resonance imaging and spectroscopy. J Am Soc Nephrol. Published online March 9, 2023. doi:10.1681/ASN.0000000000000105