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The impact of hemodialysis on cognitive dysfunction in patients with end-stage renal disease: a resting-state functional MRI study

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Abstract

To investigate the effect of hemodialysis (HD) on cognitive dysfunction in patients with end-stage renal disease (ESRD) using resting-state functional MR imaging (rs-fMRI) with regional homogeneity (ReHo) and functional connectivity algorithms. The rs-fMRI data were acquired in 58 ESRD patients (HD patients, n = 32, 22 male and 10 female, mean age 36.5 ± 9.6 years; non-HD ESRD patients, n = 26, 16 male and 10 female, mean years of 35.6 ± 8.2) and 32 healthy controls (22 male and 10 female, mean years of 32.7 ± 8.8). A battery of neuropsychological and blood laboratory tests were prescribed. The Kendall’s coefficient of concordance (KCC) was used to measure ReHo for each subject. The ReHo maps were compared by using ANOVA tests among HD, non-HD, and healthy control groups. Regions showing ReHo differences between HD and non-HD patients were defined as seeds for further functional connectivity analysis. A multiple regression analysis was performed to evaluate the relationships between ReHo index and neuropsychological tests, serum creatinine and urea levels, disease and dialysis duration. Compared with healthy controls, both HD patients and non-HD patients showed decreased ReHo in the multiple areas of bilateral frontal, parietal and temporal lobes. Compared with the non-HD, HD patients showed decreased ReHo mainly in default mode network (DMN) including bilateral precuneus, posterior cingulate cortex, inferior parietal lobe, right postcentral gyrus, bilateral superior temporal gyri, right supramarginal gyrus and right angular gyrus. Some reduced ReHo brain regions correlated with some neuropsychological tests, serum creatinine and urea levels, and dialysis duration. Brain regions with ReHo reduction showed increased region-to-region functional network in HD patients compared with non-HD patients. Widespreadly decreased ReHo values were found in both HD and non-HD patients. Lower ReHo values mainly in the DMN correlated with cognition impairments were observed in HD patients compared with non-HD patients, while increased functional connectivity was found between these brain regions. HD might have an adverse effect on the cognitive function in ESRD patients.

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Abbreviations

BOLD:

Blood oxygen level dependent

DMN:

Default mode network

DST:

Digit-symbol test

ESRD:

End-stage renal disease

HD:

Hemodialysis

IPL:

Inferior parietal lobe

KCC:

Kendall’s coefficient of concordance

LTT:

Line-tracing test

MPFC:

Medial prefrontal cortex

NCT-A:

Number connection test type A

non-HD:

Non-hemodialysis

PCC:

Posterior cingulate cortex

PCG:

Postcentral gyrus

PCu:

Precuneus

rs-fMRI:

Resting-state functional MRI

SDT:

Serial-dotting test

SFG:

Superior frontal gyrus

SMG:

Supramarginal gyrus

STG:

Superior temporal gyrus

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Acknowledgements

This work was supported by the grants from the Natural Scientific Foundation of China [Grant Nos. 81322020, 81230032 and 81171313 for Long Jiang Zhang], the Program for New Century Excellent Talents in the University (NCET-12-0260 for Long Jiang Zhang).

Conflict of interest

The authors disclose no conflicts.

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Authors and Affiliations

  1. Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China

    Hui Juan Chen, Rongfeng Qi, Xiang Kong, Xue Liang, Guang Ming Lu & Long Jiang Zhang

  2. National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China

    Jiqiu Wen, Zhe Zhang & Xue Li

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  1. Hui Juan Chen
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  2. Rongfeng Qi
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  3. Xiang Kong
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  4. Jiqiu Wen
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  5. Xue Liang
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  6. Zhe Zhang
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  7. Xue Li
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  8. Guang Ming Lu
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  9. Long Jiang Zhang
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Correspondence to Jiqiu Wen or Long Jiang Zhang.

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Chen, H.J., Qi, R., Kong, X. et al. The impact of hemodialysis on cognitive dysfunction in patients with end-stage renal disease: a resting-state functional MRI study. Metab Brain Dis 30, 1247–1256 (2015). https://doi.org/10.1007/s11011-015-9702-0

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  • DOI: https://doi.org/10.1007/s11011-015-9702-0

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