Analysis Of The Association Between Intestinal Flora And Cognitive Function In Maintenance Hemodialysis Patients

Objective: To evaluate the correlation between intestinal flora and cognitive function in patients on hemodialysis.Materials and Methods: 36 maintenance hemodialysis(MHD)patients at the Blood purification Center of the First Affiliated Hospital of Dalian Medical University(December 2018 to January 2019)were recruited.18 sex-,age-,and education-matched healthy volunteers were recruited,(hemodialysis/healthy=2:1).All participants were tesetd by Montreal cognitive scale and their feca were tested by 16 s r DNA sequence analysis.Eligible participants were tested by laboratory examinations and magnetic resonance imaging(including a cerebral small vessel disease(CSVD)scale and gray matter voxel-based morphology analysis).The Mann-Whitney test or T test were used for comparing the differences in cognitive function,brain structure and function,and microbial diversity and community between groups.Spearman correlation analysis was performed on genus-level intestinal flora,cognitive function,brain structure and function and laboratory examinations.Results: The scores of Montreal cognitive function scale in MHD group decreased significantly compared with healthy group(Mo CAMHD25(23,26.75)vs Mo CAhealthy27.5(24.75,28),p=0.042),especially in the subitem of visuospatial/executive,naming and language domains(p<0.05).The scores of cerebral small vessel disease in MHD group increased significantly(Score MHD2(1.25,3)compared with Scorehealthy0(0,0),p=0.001).The gray matter volume in bilateral hippocampus,right temporal lobe,middle temporal gyrus,right frontal rectal gyrus,right cingulate gyrus,left inferior frontal gyrus,left medial frontal gyrus,the postcentral gyrus of left parietal lobe and the anterior lobe of the right cerebellum significantly contracted(p<0.001,p<0.01 after false detection rate correction).There was a difference in the relative abundance of intestinal flora at phylum and genus level between groups.Six different genera(Blautia,Erysipelatoclostridium,Phascolarctobacterium,Sellimonas,Hungatella,Stenotrophomonas)increased(p<0.05),while Roseburia decreased(p<0.05).Phascolarctobacterium was correlated positively with diastolic blood pressure(r=0.38,p=0.023),visuospatial/execution(r=0.37,p=0.027),language(r=0.34,p=0.042),and cerebral small vessel disease scale(r=0.68,p=0.016),but was correlated negatively with cholesterol(r=-0.46,p=0.008).Blautia was correlated positively with sodium(r=0.49,p=0.005)and chloride(r=0.48,p=0.005),while Roseburia was correlated negatively with high-sensitivity C-reactive protein(r=-0.42,p=0.015).Conclusion: A correlation between intestinal flora pattern and cognitive function in MHD patients has been firstly identified.