Abstract
Background: Functional connectivity detected by resting-state functional MRI (R-fMRI) helps to discover the subtle changes in brain activities. Patients with end-stage renal disease (ESRD) on hemodialysis (HD) have impaired brain networks. However, the functional changes of brain networks in patients with ESRD undergoing peritoneal dialysis (PD) have not been fully delineated, especially among those with preserved cognitive function. Therefore, it is worth knowing about the brain functional connectivity in patients with PD by using R-fMRI.Methods: This case-control study prospectively enrolled 19 patients with ESRD receiving PD and 24 age- and sex- matched controls. All participants without a history of cognitive decline received mini-mental status examination (MMSE) and brain 3-T R-fMRI. Comprehensive R-fMRI analyses included graph analysis for connectivity and seed-based correlation networks. Independent t-tests were used for comparing the graph parameters and connectivity networks between patients with PD and controls.Results: All subjects were cognitively intact (MMSE > 24). Whole-brain connectivity by graph analysis revealed significant differences between the two groups with decreased global efficiency (Eglob, p < 0.05), increased betweenness centrality (BC) (p < 0.01), and increased characteristic path length (L, p < 0.01) in patients with PD. The functional connections of the default-mode network (DMN), sensorimotor network (SMN), salience network (SN), and hippocampal network (HN) were impaired in patients with PD. Meanwhile, in DMN and SN, elevated connectivity was observed in certain brain regions of patients with PD.Conclusion: Patients with ESRD receiving PD had specific disruptions in functional connectivity. In graph analysis, Eglob, BC, and L showed significant connectivity changes compared to the controls. DMN and SN had the most prominent alterations among the observed networks, with both decreased and increased connectivity regions. Our study confirmed that significant changes in cerebral connections existed in cognitively intact patients with PD.
Highlights
End-stage renal disease (ESRD) causes a severe burden on global public health and has a poor prognosis
The peritoneal dialysis (PD) duration for each patient is listed in Supplementary Table 2
Our findings suggested that patients with PD had functional connectivity profiles that were significantly different from controls, based on both graph analysis and seed-based network analysis
Summary
End-stage renal disease (ESRD) causes a severe burden on global public health and has a poor prognosis. The underlying mechanism of higher incidence of cerebral diseases in patients with ESRD, the so-called “kidney–brain axis,” is complicated. Beyond the structural alterations, resting-state functional MRI (R-fMRI) recently has become a valuable tool in discovering functional changes of brain networks in patients with ESRD. Patients with end-stage renal disease (ESRD) on hemodialysis (HD) have impaired brain networks. The functional changes of brain networks in patients with ESRD undergoing peritoneal dialysis (PD) have not been fully delineated, especially among those with preserved cognitive function. It is worth knowing about the brain functional connectivity in patients with PD by using R-fMRI
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