Structural and Functional Brain Alterations in End Stage Renal Disease Patients on Routine Hemodialysis: A Voxel-Based Morphometry and Resting State Functional Connectivity Study

Abstract

Background and PurposeCognitive impairment is a well-described phenomenon in end-stage renal disease (ESRD) patients. However, its pathogenesis remains poorly understood. The primary focus of this study was to examine structural and functional brain deficits in ESRD patients.Materials and MethodsThirty ESRD patients on hemodialysis (without clinical neurological disease) and 30 age- and gender-matched control individuals (without renal or neurological problems) were recruited in a prospective, single-center study. High-resolution structural magnetic resonance imaging (MRI) and resting state functional MRI were performed on both groups to detect the subtle cerebral deficits in ESRD patients. Voxel-based morphometry was used to characterize gray matter deficits in ESRD patients. The impact of abnormal morphometry on the cerebral functional integrity was investigated by evaluating the alterations in resting state functional connectivity when brain regions with gray matter volume reduction were used as seed areas.ResultsA significant decrease in gray matter volume was observed in ESRD patients in the bilateral medial orbito-prefrontal cortices, bilateral dorsal lateral prefrontal cortices, and the left middle temporal cortex. When brain regions with gray matter volume reduction were used as seed areas, the integration was found to be significantly decreased in ESRD patients in the fronto-cerebellum circuits and within prefrontal circuits. In addition, significantly enhanced functional connectivity was found between the prefrontal cortex and the left temporal cortex and within the prefrontal circuits.ConclusionsOur study revealed that both the structural and functional cerebral cortices were impaired in ESRD patients on routine hemodialysis.

Association of Kidney Function Biomarkers with Brain MRI Findings: The BRINK Study

“…In the regression analyses with UACR, however, the impact on temporal lobe atrophy was still significant, suggesting that UACR may be a stronger biomarker for neurodegenerative mechanisms, or that the temporal lobe changes may are the first neurodegenerative changes seen in the natural history of the progression of CKD and structural MRI changes. Recent literature on the effect of kidney function on GM suggests that the impact on GM is minimal in mild-moderate stages of CKD and significant in end stage renal disease [8, 35, 36], lending support to our results.…”

Structural and Functional Alterations in Hemodialysis Patients: A Voxel-Based Morphometry and Functional Connectivity Study

“…Rectal gyrus is the one part of the prefrontal cortex (PFC) and the reduction of GMV in the PFC of hemodialysis patients detected in our study was consistent with the findings reported in previous studies. The hemodialysis patients exhibited GMV reduction in several regions including the bilateral medial orbitofrontal cortex, the bilateral dorsolateral PFC, and the left middle temporal gyrus, as reported by Qiu et al (2014). Ma et al (2014) further showed that the GMV of the bilateral PFC, temporal gyrus, anterior cingulate gyrus, and other widespread regions were decreased in hemodialysis patients.…”

Brain Default Mode Network Changes after Renal Transplantation: A Diffusion-Tensor Imaging and Resting-State Functional MR Imaging Study

“…These results positively correlated with neuropsychologic scores (13)(14)(15)(16). In recent studies (17)(18)(19)(20) of resting-state functional MR imaging, investigators have shown abnormal brain functional connectivity, particularly in the default mode network (DMN), in patients with ESRD. The DMN is believed to be involved in the core processes of human …”