Abstract
PurposeTo investigate the pattern of spontaneous neural activity in patients with end-stage renal disease (ESRD) with and without neurocognitive dysfunction using resting-state functional magnetic resonance imaging (rs-fMRI) with a regional homogeneity (ReHo) algorithm.Materials and Methodsrs-fMRI data were acquired in 36 ESRD patients (minimal nephro-encephalopathy [MNE], n = 19, 13 male, 37±12.07 years; non-nephro-encephalopathy [non-NE], n = 17, 11 male, 38±12.13 years) and 20 healthy controls (13 male, 7 female, 36±10.27 years). Neuropsychological (number connection test type A [NCT-A], digit symbol test [DST]) and laboratory tests were performed in all patients. The Kendall's coefficient of concordance (KCC) was used to measure the regional homogeneity for each subject. The regional homogeneity maps were compared using ANOVA tests among MNE, non-NE, and healthy control groups and post hoc t -tests between each pair in a voxel-wise way. A multiple regression analysis was performed to evaluate the relationships between ReHo index and NCT-A, DST scores, serum creatinine and urea levels, disease and dialysis duration.ResultsCompared with healthy controls, both MNE and non-NE patients showed decreased ReHo in the multiple areas of bilateral frontal, parietal and temporal lobes. Compared with the non-NE, MNE patients showed decreased ReHo in the right inferior parietal lobe (IPL), medial frontal cortex (MFC) and left precuneus (PCu). The NCT-A scores and serum urea levels of ESRD patients negatively correlated with ReHo values in the frontal and parietal lobes, while DST scores positively correlated with ReHo values in the bilateral PCC/precuneus, MFC and inferior parietal lobe (IPL) (all P<0.05, AlphaSim corrected). No significant correlations were found between any regional ReHo values and disease duration, dialysis duration and serum creatinine values in ESRD patients (all P>0.05, AlphaSim corrected).ConclusionDiffused decreased ReHo values were found in both MNE and non-NE patients. The progressively decreased ReHo in the default mode network (DMN), frontal and parietal lobes might be trait-related in MNE. The ReHo analysis may be potentially valuable for elucidating neurocognitive abnormalities of ESRD patients and detecting the development from non-NE to MNE.
Highlights
End stage renal disease (ESRD), an increasingly prevalent multi-symptom illness complex resulting from chronic kidney failure, has been shown to co-occur with abnormal brain function [1]
The NCT-A scores and serum urea levels of ESRD patients negatively correlated with regional homogeneity (ReHo) values in the frontal and parietal lobes, while digit-symbol test (DST) scores positively correlated with ReHo values in the bilateral posterior cingulate cortex (PCC)/precuneus, medial frontal cortex (MFC) and inferior parietal lobe (IPL)
No significant correlations were found between any regional ReHo values and disease duration, dialysis duration and serum creatinine values in ESRD patients
Summary
End stage renal disease (ESRD), an increasingly prevalent multi-symptom illness complex resulting from chronic kidney failure, has been shown to co-occur with abnormal brain function [1]. Sex (M/F) Age (6SD), y S.creatinine (in mmol/L) S.urea (in mmol/L) Disease duration(m) Dialysis duration(m) NCT-A (s) DST (score) LTT(s) SDT(s) MNE (n = 19). BThe P value for age and neuropsychological tests difference among the three groups were obtained by one-way analysis of variance. CThe P value for difference of serum creatinine and urea, disease and dialysis duration between the two groups was obtained by two-sample t test
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