Altered Spontaneous Brain Activity and Functional Integration in Hemodialysis Patients With End-Stage Renal Disease

Huanhuan Su,Shishun Fu,Xianyue Quan,Yi Yin,Mengchen Liu,Guihua Jiang,Kelei Hua,Shandong Meng

doi:10.3389/fneur.2021.801336

Abstract

PurposeUsing the amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) algorithm to study the alteration of brain function in hemodialysis patients with end-stage renal disease (ESRD).Patients and MethodsWe recruited 20 patients with ESRD on regular hemodialysis and 17 healthy controls (HCs). All of the participants underwent resting-state fMRI (rs-fMRI), neuropsychological tests, and blood biochemical examination. The individual ALFF values between the two groups were tested by an independent sample t-test. Then, we set the altered ALFF brain areas as seed regions of interest (ROIs), and FC analysis was used to investigate the functional integration patterns between the seed ROI and the voxels within the whole brain.ResultsThe ALFF values of the right precuneus and angular gyrus (RAG) in the ESRD group were lower than those in the HC subjects, but the right precentral gyrus showed higher ALFF values in patients. Hemoglobin (Hb) was negatively correlated with the ALFF values of the right precentral gyrus, and the ALFF values of the right precuneus were negatively correlated with line-tracing test (LTT) scores in patients with ESRD. Patients with ESRD show decreased connectivity between the RAG and the left precuneus, right superior frontal gyrus (RSFG), and the connectivity within the RAG was weak. In addition, FC in the RAG-right cuneus, right precuneus-left supramarginal gyrus was enhanced in the patient group.ConclusionOur research suggested that, in hemodialysis patients with ESRD, the brain areas with abnormal spontaneous brain activity and FC are mainly located in the default mode network (DMN) regions. Hb and the LTT results were correlated with abnormal spontaneous brain activity. These findings provide additional evidence to understand the possible underlying neuropathological mechanisms in patients with ESRD.

Highlights

Cognitive impairment is common in patients with endstage renal disease (ESRD), especially in those who have received hemodialysis [1,2,3]
There was no significant difference in age, sex, education, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), number connection test type A and B (NCT-A/B), serial dotting test (SDT), digit symbol test (DST), and line tracing test (LTT) between the patient and control groups
The right precentral gyrus exhibited increased ALFF values in patients with ESRD compared with controls (Figure 1; Table 2)

Summary

Introduction

Cognitive impairment is common in patients with endstage renal disease (ESRD), especially in those who have received hemodialysis [1,2,3]. These cognitive deficits include concentration decline [4], executive disorder, cognitive slowing, disorientation, and memory and language disturbance [5,6,7]. This might affect the ability of patients to undergo cooperative treatment and reduce their life. Studying the cognitive impairment pattern of hemodialysis patients with ESRD, and elucidating its pathophysiological mechanism, can help to prevent disease progression and ameliorate the prognosis of the patients

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