Resting-state BOLD-CBF coupling in end-stage renal disease with diabetic kidney disease patients: associations with clinical characteristics and cognitive function.

Patients with chronic kidney disease often exhibit impaired brain function; however, the differences between those with non-diabetic kidney disease (non-DKD) and diabetic kidney disease (DKD) remain poorly understood. This study aimed to investigate alterations in resting-state brain activity in patients with non-DKD and DKD. Thirty non-DKD patients, thirty DKD patients, and twenty-nine healthy controls underwent laboratory examinations and resting-state functional magnetic resonance imaging (rs-fMRI). The brain activity was analyzed using the amplitude of low-frequency fluctuations (ALFF) and seed-based functional connectivity (FC), and correlations between laboratory indicators and FC were examined. Both non-DKD and DKD groups exhibited reduced ALFF in several brain regions, including the bilateral putamen, alongside elevated ALFF in the left middle occipital gyrus. Seed-based FC analysis revealed decreased connectivity between bilateral putamen and several regions, including decreased FC between the left putamen and left caudate. Compared with the non-DKD group, the DKD group demonstrated reduced ALFF in the left putamen and right precuneus, along with decreased FC between the right putamen and right thalamus. Several biomarkers, including urinary protein-to-creatinine ratio (UPCR), C-reactive protein (CRP), and hemoglobin (HGB), were associated with observed FC alterations. Our findings indicate that DKD patients exhibit distinct patterns of brain activity compared to non-DKD patients, with the putamen potentially acting as a key neural target in the progression of CKD. These functional alterations correlate closely with systemic status, suggesting a significant role in the pathogenesis of neural impairment. Our results may enhance the understanding of neural functional alterations and the underlying mechanisms in non-DKD and DKD patients.

Genetic factors play an important role in the pathogenesis of diabetic kidney disease (DKD). Studies have shown that SIRT2 gene polymorphism is associated with the pathogenesis of type 2 diabetes mellitus (T2DM), but its role in DKD remains unclear. This study aims to analyze the distribution of alleles and genotypes of SIRT2 gene in patients with T2DM, and investigate the association between SIRT2 genetic polymorphism and DKD susceptibility in T2DM patients, which may provide new ideas for the pathogenesis of DKD. A toal of 205 T2DM patients who receiving treatment in the Third Xiangya Hospital of Central South University were divided into a DKD group (n=100) and a DM group (n=105) according to the presence of kidney injury, and 100 healthy volunteers were selected as NC group. Clinical data of the subjects were collected and estimated glomerular filtration rate (eGFR) were calculated. Genomic DNA was extracted and the genotypes of single nucleotide polymorphism (SNP) loci (rs11879029, rs11879010, and rs2241703) were determined using Sanger chain termination method. The genotype/allele frequencies among the 3 groups were compared. Logistic regression was used to analyze the correlation between SNP locus genotype of SIRT2 gene and risk of DKD in T2DM patients. According to the genotypes of rs11879029/rs11879010, T2DM patients were divided into a GG1/GG2 group, a GA1/GA2 group, and an AA1/AA2 group, and the clinical data were compared. Linkage disequilibrium analysis and haplotype analysis were performed. The genotype distribution and allele frequencies of the rs11879029 and rs11879010 loci in the DKD group were significantly different in comparison with the NC and DM groups (all P<0.05). For rs2241703, there were no differences in genotype and allele frequencies (all P>0.05). After correcting by age, gender, systolic blood pressure, duration of diabetes, glycosylated hemoglobin, and serum albumin, rs11879029 and rs11879010 genotype were associated with DKD susceptibility in T2DM patients. Carriers of rs11879029 genotype AA were 6.27 times more likely to have DKD than carriers of genotype GG. And carriers of rs11879010 genotype AA were 4.72 times more likely to have DKD than carriers of genotype GG. The eGFR levels in the AA1/AA2 groups were significantly lower than those in the GG1/GG2 groups (both P<0.05). Analysis of linkage disequilibrium showed complete linkage disequilibrium existed between SIRT2 rs11879029 and rs11879010, and the 2 SNPs (rs11879029 and rs11879010) were in strong linkage disequilibrium with rs2241703. Monotype GGG reduced the risk of DKD in T2DM patients (OR=0.53, 95% CI 0.35 to 0.81, P=0.003), while haplotype AAG increased the risk of DKD in patients (OR=1.80, 95% CI 1.16 to 2.80, P=0.008). The genetic polymorphisms rs11879029 and rs11879010 of SIRT2 gene are potential contributors to the susceptibility of DKD in patients with T2DM, and allele A significantly increases the risk of DKD compared with allele G. The AA genotype might be a genetic risk factor for DKD.

End-stage renal disease (ESRD) patients often have cognitive dysfunction. The abnormal changes in the brains of ESRD patients are difficult to detect with routine imaging examination. Cognitive performance scales are also not an ideal tool because assessments using these scales can be subjective and might be difficult to administer in some ESRD patients. Functional magnetic resonance has the advantages of non-radiation, multidirectional imaging, good repeatability. Using resting-state functional magnetic resonance imaging (rs-fMRI) and an amplitude of low-frequency fluctuation (ALFF) algorithm, this study characterized spontaneous brain activity and explored its relationship with cognitive function in ESRD patients. The aim of this study was to provide objective functional imaging evidence to reveal the pathophysiological mechanism of cognitive dysfunction in ESRD patients. This study recruited 35 ESRD patients and 25 healthy controls (HC) who were matched to the ESRD group by age, sex, and years of education. All study subjects were examined by Montreal Cognitive Assessment (MoCA) and rs-fMRI. Data Processing & Analysis of Brain Imaging (DPABI) V4.3 software was used to preprocess the data to obtain ALFF maps. The ALFF value of the cingulate gyrus was compared between the ESRD and HC groups. Subsequently, the correlation between the ALFF value of the cingulate gyrus and the MoCA score was analyzed in ESRD patients. Compared with the HC group, the ESRD group had a significantly lower MoCA score (P<0.05). The ALFF values of the anterior and middle cingulate gyri were significantly lower in the ESRD patients (Gaussian random field (GRF) corrected, voxel-level significance: P<0.001, cluster-level significance: P<0.05). No increased ALFF was observed in any brain regions. The ALFF values of the bilateral anterior cingulate gyri were positively correlated with the MoCA scores (r=0.768, 0.625, GRF corrected, voxel-level significance: P<0.01, cluster-level significance: P<0.05). Patients with ESRD showed impaired spontaneous brain activity in the bilateral anterior and middle cingulate gyri, suggesting that ALFF of the anterior cingulate gyrus may be an imaging indicator of cognitive dysfunction in ESRD patients.

Objective: To explore the correlation between the morphological characteristics of retinal microvessels and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). Methods: The clinical data and fundus photography of patients with T2DM treated in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 were retrospectively collected and analyzed. According to the presence of abnormal renal function, the patients were divided into DKD group and control group. The morphology and structure of fundus vessels were digitized by U-Net depth convolution neural network, and the correlation between fundus vascular morphology and DKD was analyzed by multivariate logistic regression. Results: A total of 648 patients with T2DM were enrolled, including 410 males and 238 females, and aged (53±10) years. There were 398 and 250 cases in control and DKD groups, respectively. Meanwhile, 1 296 fundus images were collected. Compared with control group, the male ratio (68.4% vs 60.1%, P=0.032), age [(54±9) vs (52±10) years, P=0.005], blood pressure [(136.8±17.3) vs (130.3±15.4) mmHg（1 mmHg=0.133 kPa）, P<0.001], total cholesterol [(4.5±1.4) vs (4.2±1.0) mmol/L, P=0.009], triglyceride [M (Q1, Q3)][1.7 (1.2, 3.0) vs 1.4 (1.0, 2.3) mmol/L, P<0.001] and Cystatin C [(0.9 (0.8, 1.0) vs 0.8 (0.7, 0.9) mg/L, P<0.001] were higher in the DKD group, while high-density lipoprotein [(1.0±0.3) vs (1.1±0.3) mmol/L, P=0.001] was lower in the DKD group. Multivariate logistic regression analysis showed that the risk of DKD in the third quartile (right eye: OR=1.825, 95%CI: 1.204-2.768, P=0.005) and fourth quartile (left eye: OR=1.929, 95%CI: 1.218-3.055, P=0.005) was higher than that in the lowest quartile of vascular curvature after adjusting for age and gender. The increase of average diameter of retinal vein was associated with the risk of DKD (left eye: OR=1.044, 95%CI: 1.013-1.075, P=0.005). The decrease of vascular fractal dimension (fourth quartile of left eye: OR=0.444, 95%CI: 0.199-0.987, P=0.046) and retinal vascular density (the second and fourth quartile of the right eye: OR=0.639, 95%CI: 0.409-0.998, P=0.049; OR=0.534, 95%CI: 0.331-0.864, P=0.010) were related to the risk of DKD. Conclusions: The abnormal morphological characteristics of retinal microvessels are related to the occurrence of DKD. The increase of retinal vein diameter and the decrease of retinal vessel density correlate with the occurrence of DKD.

BackgroundCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) mainly manifests with cognitive impairment. Cognitive deficits in patients with CADASIL are correlated with structural brain changes such as lacunar lesion burden, normalized brain volume, and anterior thalamic radiation lesions, but changes in resting-state functional brain activity in patients with CADASIL have not been reported.MethodsThis study used resting-state functional magnetic resonance imaging (fMRI) to measure the amplitude of low-frequency fluctuation (ALFF) in 22 patients with CADASIL and 44 healthy matched controls. A seed-based functional connectivity (FC) analysis was used to investigate whether the dysfunctional areas identified by ALFF analysis exhibited abnormal FC with other brain areas. Pearson’s correlation analysis was used to detect correlations between the ALFF z-score of abnormal brain areas and clinical scores in patients with CADASIL.ResultsPatients with CADASIL exhibited significantly lower ALFF values in the right precuneus and cuneus (Pcu/CU) and higher ALFF values in the bilateral superior frontal gyrus (SFG) and left cerebellar anterior and posterior lobes compared with controls. Patients with CADASIL showed weaker FC between the areas with abnormal ALFF (using peaks in the left and right SFG and the right Pcu/CU) and other brain areas. Importantly, the ALFF z-scores for the left and right SFG were negatively associated with cognitive performance, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment scores (MoCA), respectively, whereas those of the right Pcu/CU were positively correlated with the MMSE score.ConclusionsThis preliminary study provides evidence for changes in ALFF of the right Pcu/CU, bilateral SFG and left cerebellar anterior and posterior lobes, and associations between ALFF values for abnormal brain areas and cognitive performance in patients with CADASIL. Therefore, spontaneous brain activity may be a novel imaging biomarker of cognitive impairment in this population.

ABSTRACTBackgroundNeurovascular coupling (NVC), as indicated by a comprehensive analysis of the amplitude of low-frequency fluctuation (ALFF) and cerebral blood flow (CBF), provides mechanistic insights into neurological disorders. Patients undergoing peritoneal dialysis (PD) and hemodialysis (HD) often face cognitive impairment, the causes of which are not fully understood.MethodsALFF was derived from functional magnetic resonance imaging, and CBF was quantified using arterial spin labeling in a cohort comprising 58 patients with PD, 60 patients with HD and 62 healthy controls. Voxel-based global analysis for both ALFF and CBF, alongside region-based analyses of ALFF-CBF coupling coefficients, were conducted. Additionally, the study explored the correlation between clinical laboratory indices and imaging metrics.ResultsCompared with HC, NVC was reduced in the bilateral medial superior frontal gyrus (SFGmed), insula, posterior cingulate cortex (PCC) and caudate (CAU) among dialysis patients. Furthermore, the PD group exhibited lower NVC in the bilateral SFGmed, bilateral PCC and left CAU compared with the HD group. Within the PD group, sodium level was negatively correlated with the ALFF-CBF coupling coefficient in the right insula. Additionally, a positive correlation emerged between the ALFF-CBF coupling coefficient in bilateral SFGmed and the dialysis adequacy.ConclusionWhile Montreal Cognitive Assessment scores did not significantly differ between patients with PD and HD, PD group demonstrated poorer NVC in the bilateral SFGmed, bilateral PCC and left CAU. Sodium level and dialysis adequacy may affect NVC in patients with PD.

Background: Diabetes mellitus (DM) is a major cause of chronic kidney disease (CKD) leading to diabetic kidney disease (DKD). Several studies have observed lipid profile abnormalities in non-diabetic CKD patients with and without haemodialysis. Our study aims to reveal lipid profile abnormalities both in DKD and non-diabetic CKD patients on haemodialysis.Methods: A prospective comparative study included 50 DKD and 50 non-diabetic CKD patients on haemodialysis and 50 controls after fulfilling the inclusion and exclusion criteria. The demographic and biochemical, including lipid profile parameters data of all subjects was collected and statistically analysed. p&lt;0.05 was considered as statically significant.Results: A total of 100 study patients, 50 DKD and 50 non-diabetic CKD patients, both on haemodialysis revealed significant dyslipidaemia when compared to controls. Total cholesterol in DKD patients on haemodialysis when compared to controls (177.5±80.5 versus 146.5±31.8 mg/dl) was significantly elevated (p=0.01). Low density lipoprotein (LDL) in DKD patients when compared to controls (94.1±43.3 versus 76.3±26.3 mg/dl) was also significantly elevated (p=0.01). Triglyceride levels in both DKD and non-diabetic CKD patients on haemodialysis in comparison to controls (213.8±182.1 and 169.2±132.3 versus 109.2±28.9 mg/dl respectively) were significantly elevated (p=0.0002 and p=0.003 respectively). Similarly, very low-density lipoprotein (VLDL) levels in both DKD and non-diabetic CKD patients were also significantly elevated when compared to controls (p=0.002 and p=0.003 respectively) whereas high density lipoprotein (HDL) was significantly reduced.Conclusion: Both DKD and non-diabetic CKD patients on haemodialysis revealed significant dyslipidaemia, a major cause of increased risk for cardiovascular diseases necessitating early treatment with statins.

Background: Estimated glomerular filtration rate (eGFR) is a vital indicator of kidney function, particularly in patients receiving treatments that may impact renal health, such as intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections like bevacizumab. Bevacizumab, commonly used to treat retinal diseases like diabetic retinopathy, has raised concerns about its potential systemic effects, including its impact on kidney function due to the role of VEGF in maintaining glomerular integrity. This study investigates the effect of bevacizumab injections on renal function in patients with diabetic kidney disease (DKD) and those without. Objective: To assess changes in eGFR before and after intravitreal bevacizumab injections in patients with and without diabetic kidney disease, evaluating whether these injections significantly affect renal function. Methodology: This quasi-experimental study was conducted in the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), from April 2019 to August 2021. Forty patients with diabetic retinopathy were selected, divided equally into DKD and non-DKD groups. Serum creatinine and eGFR were measured within 30 days before the injection and one month after the third dose of intravitreal bevacizumab. eGFR was calculated using the CKD-EPI equation, and statistical analysis was performed using SPSS. Results: The mean pre-injection eGFR was 69.35±25.91 ml/min/1.73m² in the DKD group and 96.7±30.59 ml/min/1.73m² in the non-DKD group. Post-injection, the mean eGFR was 73.3±33.87 ml/min/1.73m² in DKD patients and 93.6±29.7 ml/min/1.73m² in non-DKD patients. The mean differences in eGFR were not statistically significant between pre- and post-injection measurements in either group (p&gt;0.05). Conclusion: Intravitreal bevacizumab injections did not cause significant changes in eGFR in both DKD and non-DKD patients, suggesting that the treatment is unlikely to have a detrimental impact on renal function in the short term. Further studies are needed to assess the long-term effects of repeated injections.

BackgroundAltered cerebral blood flow (CBF) and amplitude of low-frequency fluctuation (ALFF) have been reported in hemodialysis patients. However, neurovascular coupling impairments, which provide a novel insight into the human brain, have not been reported in hemodialysis patients.MethodsWe combined arterial spin labeling (ASL) and blood oxygen level dependent (BOLD) techniques to investigate neurovascular coupling alterations and its relationships with demographic and clinical data in 46 hemodialysis patients and 47 healthy controls. To explore regional neuronal activity, ALFF was obtained from resting-state functional MRI. To measure cerebral vascular response, CBF was calculated from ASL. The across-voxel CBF–ALFF correlations for global neurovascular coupling and CBF/ALFF ratio for regional neurovascular coupling were compared between hemodialysis patients and healthy controls. Two-sample t-tests were used to compare the intergroup differences in CBF and ALFF. Multiple comparisons were corrected using a voxel-wise false discovery rate (FDR) method (P < 0.05).ResultsAll hemodialysis patients and healthy controls showed significant across-voxel correlations between CBF and ALFF. Hemodialysis patients showed a significantly reduced global CBF–ALFF coupling (P = 0.0011) compared to healthy controls at the voxel-level. Of note, decreased CBF/ALFF ratio was exclusively located in the bilateral amygdala involved in emotional regulation and cognitive processing in hemodialysis patients. In hemodialysis patients, the decreased CBF (right olfactory cortex, anterior cingulate gyrus and bilateral insula) and ALFF (bilateral precuneus and superior frontal gyrus) were mainly located in the default mode network and salience network-related regions as well as increased CBF in the bilateral thalamus.ConclusionsThese novel findings reveal that disrupted neurovascular coupling may be a potential neural mechanism in hemodialysis patients.

This study aimed to compare the differences in echocardiographic and strain parameters in patients with diabetic kidney disease (DKD) and non-diabetic kidney disease (NDKD) in a cohort with pre-dialysis chronic kidney disease (CKD) and normal ejection fraction (EF). In this single-center prospective study, patients with CKD stages 3–5 and EF > 55% were included. We compared cardiac structure and function using conventional and speckle-tracking strain echocardiography among DKD and NDKD groups. Cardiovascular outcomes were assessed at the end of the study. Of the included 117 patients, 56 (47.9%) had DKD, and 61 (52.1%) had NDKD. Patients with DKD had higher ratios of early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) (11.9 ± 4.4 vs. 9.8 ± 3.5; p = 0.004), lower septal e’ velocity (7.1 ± 2.5 vs. 8.2 ± 2.8; p = 0.031), lower lateral e’ velocity (9.2 ± 2.9 vs. 10.4 ± 3.8; p = 0.045) and longer deceleration times (209.2 ± 41.5 vs. 189.1 ± 48.0; p = 0.017), compared to those with NDKD. Left ventricular mass index (LVMI), global longitudinal strain (GLS), early diastolic strain rate (SRE), and E/SRE were similar. At a median follow-up of 239 days, 3-P MACE (11.5% vs. 4.9%; p = 0.047) and 4-P MACE (28.6% vs. 11.5%; p = 0.020) were observed to be higher in the DKD group. Diastolic dysfunction was more common in patients with DKD, compared to those with NDKD, although both groups had similar LVMI and GLS. Those with DKD also had poorer cardiovascular outcomes. This highlights the importance of the assessment of diastolic function in CKD, particularly in those with diabetic CKD.

Objectives To investigate glymphatic function in nondialysis-dependent ESRD (ND-ESRD) patients with diabetic kidney disease (DKD) or non-DKD using the diffusion tensor image analysis along the perivascular space (DTI-ALPS) method and choroid plexus (CP) volume to explore the associations among DTI-ALPS index, CP volume, clinical characteristics, and cognitive function. Methods 25 DKD patients, 25 non-DKD patients, and 25 healthy control (HC) were included in this study. All participants underwent cerebral MRI and cognitive assessments. Bilateral DTI-ALPS index and CP volume were calculated and were compared among three groups. Correlations among the DTI-ALPS index, CP volume, clinical characteristics, and cognitive function were analyzed. Results DKD patients had significantly lower left DTI-ALPS index (p = 0.001) and mean DTI-ALPS index (p = 0.003) than non-DKD patients. In ND-ESRD patients, there was a significant positive correlation between the left DTI-ALPS index and phosphorus (r = 0.377, p = 0.007) and attention score (r = 0.434, p = 0.002). In DKD group, the mean DTI-ALPS was positively correlated with total cholesterol (r = 0.631, p = 0.001). In non-DKD group, there was a significant positive correlation between the left DTI-ALPS index and phosphorus (r = 0.696, p < 0.001). Both DKD and non-DKD patients exhibited significant higher CP volume than HC group. In non-DKD group, CP volume was negatively correlated with mean DTI-ALPS (r = −0.535, p = 0.006) and attention score of MoCA (r = −0.538, p = 0.006). Conclusions Glymphatic system dysfunction may contribute to the pathogenesis of clinical and cognitive impairment in ND-ESRD patients especially with DKD.

Objective To investigate the prevalence of Helicobacter pylori infection and the incidence of gastric mucosal lesions in type 2 diabetes mellitus(DM) and diabetic kidney disease(DKD) patients with dyspepsia symptoms. Methods A total of 241 type 2 diabetic patients and 69 non-diabetic subjects with dyspeptic symptoms were enrolled in the study.Gastroduodenal lesions were observed by gastrointestinal endoscopy and the presence of Helicobacter pylori infection was identified by rapid urease test and serum IgG antibodies to Helicobacter pylori.Urine albumin excretion rate(UAE) at 24 hours was measured in all subjects.According to the urinary albumin excretion rate, patients were classified into diabetes mellitus group(DM group, with UAE 300mg/24h). Estimated glomerular filtration rate were above 60mL·min-1·(1.73m2)-1 in the three groups of patients.The 69 cases of non-diabetic subjects were used as the control group. Results The prevalence of H pylori infection in the DKD group[145/72(62.5%)]and the DKD group 2[34/53(64.15%)]were significantly higher than those in the control group[28/65(43.1%)](χ2=3.901, P=0.04; χ2=4.223, P=0.03) and the DM group[27/63 (42.9%)](χ2=4.104, P=0.04; χ2=5.116, P=0.03). No significant differences of H. pylori prevalence were detected between the DKD groups(χ2=1.304, P=0.29) as well as the DM group and the control group (χ2=0.723, P=0.40). Gastroscopy results showed that the incidence of normal endoscopic performance in the DM group was higher than that of the control group(57.1% vs.38.5%, χ2=4.612, P=0.03). There were no significant differences between the control group and DM group, DKD1 group and DKD2 group in the incidence of gastric mucosal lesions(Superficial gastritis: χ2=1.206, 0.912, 0.707; erosive gastritis: χ2=1.422, 1.836 0.870; duodenal ulcer: χ2=243.1, 1.716, 2.233; gastric ulcer: χ2=1.440, 0.971, 1.322 and esophagitis: χ2=2.116, 2.318, 2.488, all P>0.05). Conclusion Diabetic nephropathy patients are more susceptible to Helicobacter pylori infection.There is no significant difference in the infection rate of Helicobacter pylori between type 2 diabetic nephropathy with microalbuminuria and with macroalbuminuria.There are no significant differences in the type of gastric mucosal lesion between Type 2 diabetes mellitus, diabetic nephropathy patients and non diabetic patients. Key words: Diabetes mellitus, Type 2; Diabetic nephropathies; Helicobacter pylori

Urine cast analysis is a rapid, cost-effective test that may reflect changes in renal function. In the current study, we evaluated urine cast as a risk factor of the occurrence and severity of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). Hospitalised T2DM patients were classified into DKD (n=299) and Non-DKD (n=301) groups. Data on urinalysis (including casts), demographics, and biochemical parameters were compared, followed by correlation analysis using logistic regression. Receiver operating characteristic (ROC) curve was constructed to assess the diagnostic potential of urine casts for DKD. In comparison to Non-DKD patients, DKD patients showed significantly higher detection rates of granular casts (19.7% vs. 1.0%). Additionally, the DKD patients had significantly higher average counts of granular casts (0.55±1.68 vs. 0.01±0.10). Granular cast was an independent risk factor for coincident occurrence of DKD in T2DM patients (OR=4.696, 95% CI: 1.094-20.168) after multivariate adjustment. ROC analysis showed 19.7% sensitivity and 99.0% specificity (accuracy) at a cutoff of 0.5 using granular cast to diagnose DKD. Furthermore, Non-DKD patients with the presence of granular casts had a higher incidence of developing new-onset DKD than those without in 1year follow-up (66.7% vs. 12.05%). Granular cast is an independent risk factor for the occurrence and is positively associated with disease severity of DKD in patients with T2DM. The presence of granular casts also indicates an increased risk of the future development of DKD in T2DM patients.

How far is arterial spin labeling MRI from a clinical reality? Insights from arterial spin labeling comparative studies in Alzheimer's disease and other neurological disorders.

Objective To investigate the change patterns of functional brain networks and their relations with cognitive function in patients with end-stage renal disease (ESRD). Methods Sixty-two patients with ESRD (ESRD group), admitted to our hospital from July 2018 to June 2019, and 36 age-, gender-, and education level-matched healthy controls (HC group) were enrolled. Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Trail Making Test A (TMT-A), TMT-B and Symbol Digit Modalities Test (SDMT) were used to evaluate the cognitive function for all subjects. Resting-state functional magnetic resonance imaging data were acquired; after data preprocessing, the brain functional networks were constructed and the topological parameters were calculated. Statistical methods were used to compare the differences of cognitive function scores and topological parameters between the two groups, and to analyze the correlations between these topological parameters and cognitive function scores in the ESRD group. Results The MMSE, MoCA and SDMT scores of the ESRD group were significantly lower than those of the HC group (P<0.05), and the ESRD group took significantly longer time to complete TMT-A and TMT-B than the HC group (P<0.05). The ESRD group had significantly lower normalized clustering coefficient (γ), small-worldness (σ) and local efficiency (Elocal) values than the HC group (P<0.05). Patients in the ESRD group exhibited significantly decreased nodal efficiency in the paralimbic-limbic network (including the bilateral insula, median cingulate and paracingulate gyri, hippocampus, parahippocampal gyrus, amygdala, temporal pole: superior temporal gyrus, and temporal pole: middle temporal gyrus), right heschl gyrus and left superior temporal gyrus, and exhibited significantly increased nodal efficiency in the visual network (including the right distal-shaped gyrus, bilateral wedge, and left superior and middle occipital gyrus) as compared with the HC group (P< 0.05). In the ESRD group, the area under the curve (AUC) of γ and σwas positively correlated with MoCA scores (r=0.698, P=0.000; r=0.661, P=0.000), and the AUC of Elocal showed positive correlation with MMSE scores (r=0.407, P=0.003). Conclusion Abnormal topological organization of the functional brain networks is revealed in patients with ESRD, which affects the cognitive function of these patients. Key words: End-stage renal disease; Cognitive impairment; Functional brain network; Resting-state functional magnetic resonance imaging; Graph theory