Altered Brain Function In End-stage Renal Disease Patients In Peritoneal Dialysis

Objective To detect the brain spontaneous nerve activity in end-stage renal disease(ESRD)patients with peritoneal dialysis by rest-state functional magnetic resonance imaging(rs-f MRI),and observe the characteristics of brain function changes in patients with ESRD.The relationship between brain function and neuropsychological tests and clinical data were investigated.Methods Twenty-one end-stage renal disease(ESRD)patients with peritoneal dialysis(ESRD patients group)and 20 healthy volunteers(normal controls group)matched with gender,age and education were collected during the same period.All subjects underwent rs-f MRI scan and neuropsychological tests,and the patient group received additional laboratory blood biochemical examinations.Using the MATLAB R2018 a and CONN v18 software to process the rs-f MRI data of two groups.Two independent samples t-test was used to determine brain regions with significance in the f ALFF,functional connectivity of DMN and brain network topological properties between the patient group and control group.In addition,the correlation analysis was used to evaluate the relationship between the brain function and the neuropsychological tests and clinical data in the ESRD patients group.Results 1.The analysis results of neuropsychological test and clinical There was no significant difference in age,education level and gender between the two groups(P >0.05).The scores of mini-mental state examination(MMSE),Montreal cognitive assessment scale(Mo CA),trail making test A(TMT-A),digit symbol substitution test(DSST),beck depression inventory(BDI),Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD)and functional independence measure(FIM)have statistically significant difference between the two grpups(P <0.05).2.The analysis results of f ALFF date 1)Compared with the normal control group,the brain region with f ALFF increase in ESRD patients include the right parhippocampus,right frontal pole,left cerebellum,left temporal pole and left frontal orbital cortex(P<0.001);The brain region with f ALFF decrease included bilateral central anterior gyrus,bilateral central posterior gyrus,precuneus,bilateral angular gyrus,left superior frontal gyrus,left middle frontal gyrus,left superior frontal gyrus and left superior occipital gyrus(P<0.001).2)The f ALFF values in central gyrus,cerebellum and right frontal pole were linearly correlated with MMSE?Mo CA,TMT-A,DSST,MAMA and FIM scores(P<0.005).3)The f ALFF values in the central gyrus,parts of frontal,occipital and temporal lobe were linearly correlated with the disease duration,BUN,UA,PTH and Hb levels(P<0.005).4)None of the regional f ALFF values showed a correlation with dialysis duration,SCr levels,BDI and HAMD scores(P>0.005).3.The analysis results of functional connectivity in the posterior cingulate gyrus 1)Compared with the normal control group,the brain areas with functional connectivity of posterior cingulate cortex enhanced in the ESRD group are bilateral occipital pole,left lingual gyrus and left occipital pole(P<0.001).The weakened brain areas are the anterior cingulate gyrus,medial frontal cortex,right superior temporal gyrus,right middle temporal gyrus,and left parahippocampal gyrus(P<0.001).2)In patients with ESRD,the functional connectivity between posterior cingulate cortex and the occipital lobe(mainly occipital pole),temporal lobe and cerebellum,show linearly correlated with the MMSE,Mo CA,TMT-A,BDI,HAMA,HAMD and FIM scores(P<0.005).3)In patients with ESRD,the functional connectivity between posterior cingulate cortex and the bilateral occipital pole,anterior frontal lobe,right hippocampal gyrus and cerebellum,show linearly correlated with the disease duration ?SCr?BUN?PTH and Hb levels(P<0.005).4)No associations were found for dialysis duration,UA levels and DSST scores with functional connectivity(P>0.005).4.The analysis results of brain network topological properties 1)Compared with the normal control group,the global efficiency of cerebellar network,frontoparietal network,salience network and default model network in ESRD patients were decreased(P<0.05);the local efficiency of dorsal attention network,language network,emotion network and default model network in ESRD patients were increased(P<0.05).2)There were linear correlation between the topological properties in the default network,salience network,frontoparietal network,cerebellar network,dorsal attention network,right amygdala,right hippocampal and TMT-A,BDI and HAMA scores in ESRD patients(P<0.05).3)there was no linear correlation between the brain network topological properties and MESS,DSST,Mo CA and HAMD scores in ESRD patients(P>0.05).Conclusion 1.This study showed that the mood and cognitive behavior of ESRD patients were significantly impaired;2.ESRD patients have brain regions with abnormal spontaneous activities,mainly involving sensorimotor,cognitive,executive control and other related functional brain regions,which are significantly related to renal injury;3.The default model network(DMN)in ESRD patients have abnormal function connection,which is significantly related to mood,cognitive function and Scr,BUN,PTH and Hb levels;4.Brain network graph analysis showed that the global effect of ESRD was weakened and the local effect was enhanced,and it was related to executive function,depression and anxiety.