Changes of Brain Functional Connectivity in End-Stage Renal Disease Patients Receiving Peritoneal Dialysis Without Cognitive Decline

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.

Altered Brain Functional Connectivity of resting-state networks in Neurologically Asymptomatic Patients with End-Stage Renal Disease Undergoing Maintenance Hemodialysis

“…The SMG is associated with episodic memory encoding, short-term auditory memory, memory processing [28][29][30]. Our results agree with many previous studies [13,[31][32][33][34][35]. For example, Huijuan Chen et al identi ed the abnormal spontaneous activity of the DMN in the PCUN and IPL/ANG using the amplitude of low-frequency uctuations (ALFFs) [33] and regional homogeneity [35] analysis, respectively, in patients undergoing HD.…”

“…Peina Chen et al [36] found a positive correlation between the DC values of the right superior frontal gyrus and neurocognitive scores in ESRD with cognitive impairment. TingYu Chang et al [32] used graph theory analysis to evaluate patients with ESRD without cognitive decline that were receiving peritoneal dialysis, nding many abnormal FC regions of the frontal gyrus and cingulate gyrus. We con rmed that the FC values of the MFG in the ESHD group are abnormal, which is inconsistent with the superior frontal gyrus reported in most previous studies.…”

Relations of hippocampal subfields atrophy patterns with memory and biochemical changes in end stage renal disease

“…Previous studies have demonstrated the associations of hippocampal structure and function abnormalities with ESRD 12 , 13 . In our research, we observed reduced volume of the right whole hippocampus, consistent with the previous findings.…”

“…The decline of memory function in CKD patients may be related to structural or functional abnormalities of the hippocampus. Indeed, studies have reported smaller hippocampus volumes and impaired hippocampal network connectivity in patients with CKD, compared with healthy controls (HCs) 12 , 13 .…”

Recent Advances in Clinical Diagnosis and Pharmacotherapy Options of Membranous Nephropathy

“…About 40% of IMN patients could suffer spontaneous remission. However, the rest of 30% showed a poor outcome to immunosuppressive treatment and finally reached end-stage renal disease treated by dialysis and transplantation ( Tesar and Hruskova, 2021 ; Passerini et al, 2019 ; Xipell et al, 2018 ; Molina Andújar et al, 2022 ; da Silva et al, 2018 ), which were two leading therapies for patients with end-stage renal disease ( Zhang et al, 2020a ; Sawhney and Gill, 2020 ; Wu et al, 2021a ; Bacharaki et al, 2021 ; Chang et al, 2021 ; Chuengsaman et al, 2021 ; Gambino et al, 2021 ). Approximately, 40% patients accept kidney grafts that lead to recurrence, and about 45% patients lose the graft ( Passerini et al, 2019 ; Robson and Kitching, 2021 ; Uffing et al, 2021 ).…”