Structural and Functional Brain Changes in Hemodialysis Patients with End-Stage Renal Disease: DTI Analysis Results and ALFF Analysis Results

Abstract

Introduction The current study aimed to depict intrinsic structural changes and the spontaneous brain activity patterns in voxel level in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) by using diffusion-tensor imaging and resting-state functional magnetic resonance (MR) imaging with an amplitude of low-frequency fluctuations (ALFF) algorithm and their clinical relevance. Materials and Methods In the study, the diffusion-tensor imaging and resting-state functional MR imaging were performed in forty-two hemodialysis patients with ESRD and 42 healthy control subjects. Neuropsychological and laboratory tests were performed in all subjects. ALFF, fraction anisotropy (FA), and mean diffusivity (MD) values were compared between the two groups. Correlations between ALFF, FA or MD values, and clinical markers were analyzed. Results We found that ESRD patients exhibited significantly lower ALFF values in multiple areas, including medial frontal gyrus, limbic lobe, superior frontal gyrus, bilateral lingual gyri, occipital lobe, parahippocampal gyrus, precuneus, while increased ALFF values in medial frontal gyrus than healthy controls. FA values were decreased in medial frontal gyrus, parietal lobe, and left precuneus regions in the ESRD group compared with controls. Importantly, FA for the frontal and parietal lobes was negatively associated with the dialysis duration of ESRD patients, ALFF z-scores for the medial prefrontal cortex (MPFC) were positively correlated with the dialysis duration of ESRD patients and Serum calcium of ESRD patients negatively correlated with FA values in the frontal and parietal lobes ( p <0.05). Conclusion Our study revealed that both impaired brain structure and function in ESRD patients with routine hemodialysis distributed mainly in the parietal, temporal, and frontal lobes. ESRD patients have cognitive impairment and declined memory ability. Serum calcium and dialysis duration might be associated with the impairment of brain structure and function in patients with ESRD.

Altered Spontaneous Brain Activity and Functional Integration in Hemodialysis Patients With End-Stage Renal Disease

“…But in our study, the ALFF values of the right precentral gyrus were increased, which may suggest that the damage of the precentral gyrus was in the early stage and the compensative effect of spontaneous brain activity. Our findings of ALFF analysis are supported by the previous researches in patients with ESRD (15,(22)(23)(24)36). Liang et al revealed that patients with ESRD with minimal nephron-encephalopathy showed decreased ReHo in the right IPL, medial frontal cortex, and left precuneus, and altered ReHo values in some brain regions were correlated with neuropsychological tests and serological results (15).…”

“…To our knowledge, previous ALFF studies found that patients with ESRD have abnormal spontaneous brain activity (22)(23)(24). For instance, Luo et al found that the ALFF values of the left inferior parietal lobe (IPL), left superior parietal lobe, and left precuneus in peritoneal dialysis patients with ESRD were reduced (24).…”

K-Means Clustering Algorithm–Based Functional Magnetic Resonance for Evaluation of Regular Hemodialysis on Brain Function of Patients with End-Stage Renal Disease

“…The results suggested that the SCr and BUN levels in ESRD patients after HD treatment were relatively high. The previous studies showed that SCr and BUN were related to the damage of the brain function system in patients with ESRD [ 25 , 26 ]. After discussion, the main reason for the difference between this research and the previous results is that the patients also received HD treatment during the rs-fMRI examination.…”

Aberrant brain gray matter and functional networks topology in end stage renal disease patients undergoing maintenance hemodialysis with cognitive impairment

“…Moreover, rs-fMRI can detect low-frequency (0.01–0.08 Hz) fluctuations in blood-oxygen-level-dependent (BOLD) signals and can be used to investigate spontaneous neural activity at rest ( Barkhof et al, 2014 ). In hemodialysis patients, impaired functional integrity of extensive brain regions has been measured by using multiple analytical methods based on rs-fMRI, including regional homogeneity (ReHo), amplitude of low frequency fluctuation (ALFF), and functional connectivity (FC) ( Li et al, 2018 ; Chen et al, 2020 ; Hu et al, 2020 ; Guo et al, 2021 ). Although the above results were inconsistent due to the diverse population cohorts and methodologies used, a correlation between functional abnormalities and cognitive dysfunction was indicated.…”