Abnormal rich club organization in end-stage renal disease patients before dialysis initiation and undergoing maintenance hemodialysis

Abstract

<jats:title>Abstract</jats:title> <jats:p>Background End-stage renal disease (ESRD) patients are at substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. Based on previous research, there did not provide an uncontested result whether cognition was improved or worsened during dialysis. Methods To explore the impact of dialysis treatment on cognitive performance, we recruited healthy controls (HCs), ESRD patients before dialysis initiation (bESRD) and those undergoing maintenance hemodialysis (mESRD). All ESRD patients performed a serious of blood biochemistry tests (hemoglobin, urea, cystatin C, Na+, K + and parathyroid hormone). Neuropsychological tests were used to measure cognitive function. By using diffusion tensor imaging and graph-theory approaches, the topological organization of the whole-brain structural network was investigated. Generalized linear models (GLMs) were performed to investigate blood biochemistry predictors of the neuropsychological tests and the results of graph analyses in mESRD and bESRD groups. Results Neuropsychological analysis showed mESRD exhibited greater cognitive function than bESRD, but both were worse than HCs. Whole-brain graph analyses revealed that increased global efficiency and normalized shortest path length remained in the bESRD and mESRD than the HCs. Besides, lower normalized clustering coefficient was in bESRD relative to the HCs and mESRD. For the GLMs analysis, only the Cystatin C level was significantly associated with the average fiber length of rich club connections in bESRD. Conclusions Our study revealed that dialysis had a limited effect on cognitive improvement. Cystatin C may be a risk feature of cognitive decline of bESRD.</jats:p>

Intravoxel incoherent motion to assess brain microstructure and perfusion in patients with end‐stage renal disease

“…From October 2020 to August 2021, 49 patients were initially enrolled in the study. Participants were included if they (1) were right-handed and had normal vision; (2)…”

“…End‐stage renal disease (ESRD) is a severe problem across the world 1 . Importantly, cognitive impairment exists extensively in ESRD cases, including impaired executive function, memory, disorientation, and motor performance 1 .…”

“…1 Importantly, cognitive impairment exists extensively in ESRD cases, including impaired executive function, memory, disorientation, and motor performance. 1 Patients undergoing hemodialysis showed significantly decreased nodal centralities in the bilateral hippocampus compared with nondialysis patients, which verified that there were indeed changes in brain function in patients with end-stage nephropathy hemodialysis with cognitive dysfunction. 2 However, in ESRD patients, the emergence of cognitive impairment seriously affects their quality of life and even leads to poor prognosis.…”

Altered spontaneous brain activity and functional connectivity in patients with end-stage renal disease

“…Compared with individuals in the general population, ESRD patients are more likely to suffer from a variety of neurological complications, such as acute cerebrovascular disease and cognitive impairment, which includes declines in executive ability, memory function and language function [1][2][3][4][5][6]. Cognitive impairment affects patients' quality of life and treatment compliance, and patients have a signi cantly increased risk of anxiety, depression and even death [7][8][9]. Therefore, we urgently need to investigate the neuropathological mechanisms of cognitive impairment in patients with ESRD.…”