Abstract
Objective: Cognitive impairment (CI) is a common neurological complication in patients with end-stage renal disease undergoing maintenance hemodialysis (MHD). Brain network analysis based on graph theory is a promising tool for studying CI. Therefore, the purpose of this study was to analyze the changes of functional brain networks in patients on MHD with and without CI by using graph theory and further explore the underlying neuropathological mechanism of CI in these patients.Methods: A total of 39 patients on MHD (19 cases with CI and 20 without) and 25 healthy controls (HCs) matched for age, sex, and years of education were enrolled in the study. Resting-state functional magnetic resonance imaging (rs-fMRI) and T1-weighted high-resolution anatomical data were obtained, and functional brain networks for each subject were constructed. The brain network parameters at the global and regional levels were calculated, and a one-way analysis of covariance was used to compare the differences across the three groups. The associations between the changed graph-theory parameters and cognitive function scores in patients on MHD were evaluated using Spearman correlation analysis.Results: Compared with HCs, the global parameters [sigma, gamma, and local efficiency (Eloc)] in both patient groups decreased significantly (p < 0.05, Bonferroni corrected). The clustering coefficient (Cp) in patients with CI was significantly lower than that in the other two groups (p < 0.05, Bonferroni corrected). The regional parameters were significantly lower in the right superior frontal gyrus, dorsolateral (SFGdor) and gyrus rectus (REC) of patients with CI than those of patients without CI; however the nodal local efficiency in the left amygdala was significantly increased (all p < 0.05, Bonferroni corrected). The global Cp and regional parameters in the three brain regions (right SFGdor, REC, and left amygdala) were significantly correlated with the cognitive function scores (all FDR q < 0.05).Conclusion: This study confirmed that the topology of the functional brain network was disrupted in patients on MHD with and without CI and the disruption of brain network was more severe in patients with CI. The abnormal brain network parameters are closely related to cognitive function in patients on MHD.
Highlights
End-stage renal disease (ESRD) is defined as chronic kidney disease with a glomerular filtration rate below 15 ml/min//1.73 m2 or requiring permanent renal replacement therapy (Brouns and De Deyn, 2004).Maintenance hemodialysis (MHD) is one of the most important treatment methods.Patients with ESRD are often affected by various neurological complications, such as cognitive impairment (CI)
Montreal Cognitive Assessment Scale (MoCA) and Digit Span Task (DST) scores were significantly lower in patients with CI than in patients without CI and healthy controls (HCs) (p < 0.05, Bonferroni corrected)
Cp was significantly lower in patients with CI than in the other two groups; (2) in comparison with HCs, the altered nodal parameters (NCp and nodal local efficiency (NLe)) of patients on MHD were mainly located in the frontal and temporal lobes; (3) in comparison with patients without CI, the nodal parameters (NCp and NLe) of the prefrontal cortex (SFGdor and REC) were significantly decreased and NLe of the amygdala was significantly increased in patients with CI; and (4) several altered global and regional parameters of patients on MHD were significantly
Summary
Patients with ESRD are often affected by various neurological complications, such as cognitive impairment (CI). CI affects quality of life and mortality in patients with ESRD (Murray et al, 2006; Sarnak et al, 2013; Van Zwieten et al, 2019). Patients with ESRD undergoing hemodialysis suffer from more severe CI (Murray et al, 2006). A large number of unrecognized cognitive impairments in patients on hemodialysis have a significant impact on nutritional status, compliance with medical treatment, and hospitalization (Sehgal et al, 1997; Murray, 2008; Kwan et al, 2020). Exploration of the mechanism of hemodialysis-related cognitive decline in patients with ESRD is of great significance
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