Associations of the Disrupted Functional Brain Network and Cognitive Function in End-Stage Renal Disease Patients on Maintenance Hemodialysis: A Graph Theory-Based Study of Resting-State Functional Magnetic Resonance Imaging

Die Zhang; Yingying Chen; Hua Wu; Lin Lin; Qing Xie; Chen Chen; Li Jing; Jianlin Wu

doi:10.3389/fnhum.2021.716719

Associations of the Disrupted Functional Brain Network and Cognitive Function in End-Stage Renal Disease Patients on Maintenance Hemodialysis: A Graph Theory-Based Study of Resting-State Functional Magnetic Resonance Imaging

Front Hum Neurosci. 2021 Dec 13:15:716719. doi: 10.3389/fnhum.2021.716719. eCollection 2021.

Authors

Die Zhang^{1

2}, Yingying Chen^{1

3}, Hua Wu⁴, Lin Lin¹, Qing Xie¹, Chen Chen⁴, Li Jing¹, Jianlin Wu¹

Affiliations

¹ Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
² Department of Radiology, Shenzhen Third People's Hospital, Shenzhen, China.
³ Department of Radiology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Shenzhen Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shenzhen, China.
⁴ Department of Nephrology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.

Abstract

Objective: Cognitive impairment (CI) is a common neurological complication in patients with end-stage renal disease undergoing maintenance hemodialysis (MHD). Brain network analysis based on graph theory is a promising tool for studying CI. Therefore, the purpose of this study was to analyze the changes of functional brain networks in patients on MHD with and without CI by using graph theory and further explore the underlying neuropathological mechanism of CI in these patients. Methods: A total of 39 patients on MHD (19 cases with CI and 20 without) and 25 healthy controls (HCs) matched for age, sex, and years of education were enrolled in the study. Resting-state functional magnetic resonance imaging (rs-fMRI) and T1-weighted high-resolution anatomical data were obtained, and functional brain networks for each subject were constructed. The brain network parameters at the global and regional levels were calculated, and a one-way analysis of covariance was used to compare the differences across the three groups. The associations between the changed graph-theory parameters and cognitive function scores in patients on MHD were evaluated using Spearman correlation analysis. Results: Compared with HCs, the global parameters [sigma, gamma, and local efficiency (Eloc)] in both patient groups decreased significantly (p < 0.05, Bonferroni corrected). The clustering coefficient (Cp) in patients with CI was significantly lower than that in the other two groups (p < 0.05, Bonferroni corrected). The regional parameters were significantly lower in the right superior frontal gyrus, dorsolateral (SFGdor) and gyrus rectus (REC) of patients with CI than those of patients without CI; however the nodal local efficiency in the left amygdala was significantly increased (all p < 0.05, Bonferroni corrected). The global Cp and regional parameters in the three brain regions (right SFGdor, REC, and left amygdala) were significantly correlated with the cognitive function scores (all FDR q < 0.05). Conclusion: This study confirmed that the topology of the functional brain network was disrupted in patients on MHD with and without CI and the disruption of brain network was more severe in patients with CI. The abnormal brain network parameters are closely related to cognitive function in patients on MHD.

Keywords: cognitive impairment; end-stage renal disease; graph theory; maintenance hemodialysis; resting-state functional magnetic resonance imaging (rs-fMRI).