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Hu R, Gao L, Chen P, Wei X, Wu X, Xu H. Macroscale neurovascular coupling and functional integration in end-stage renal disease patients with cognitive impairment: A multimodal MRI study. J Neurosci Res 2024; 102:e25277. [PMID: 38284834 DOI: 10.1002/jnr.25277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/06/2023] [Accepted: 11/06/2023] [Indexed: 01/30/2024]
Abstract
End-stage renal disease (ESRD) is associated with vascular and neuronal dysfunction, causing neurovascular coupling (NVC) dysfunction, but how NVC dysfunction acts on the mechanism of cognitive impairment in ESRD patients from local to remote is still poorly understood. We recruited 48 ESRD patients and 35 demographically matched healthy controls to scan resting-state functional MRI and arterial spin labeling, then investigated the four types of NVC between amplitude of low-frequency fluctuation (ALFF), fractional ALFF, regional homogeneity, degree centrality, and cerebral blood perfusion (CBF), and associated functional networks. Our results indicated that ESRD patients showed NVC dysfunction in global gray matter and multiple brain regions due to the mismatch between CBF and neural activity, and associated disrupted functional connectivity (FC) within sensorimotor network (SMN), visual network (VN), default mode network (DMN), salience network (SN), and disrupted FC between them with limbic network (LN), while increased FC between SMN and DMN. Anemia may affect the NVC of middle occipital gyrus and precuneus, and increased pulse pressure may result in disrupted FC with SMN. The NVC dysfunction of the right precuneus, middle frontal gyrus, and parahippocampal gyrus and the FC between the right angular gyrus and the right anterior cingulate gyrus may reflect cognitive impairment in ESRD patients. Our study confirmed that ESRD patients may exist NVC dysfunction and disrupted functional integration in SMN, VN, DMN, SN and LN, serving as one of the mechanisms of cognitive impairment. Anemia and increased pulse pressure may be related risk factors.
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Affiliation(s)
- Runyue Hu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Peina Chen
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Nephrology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Xiaobao Wei
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Nephrology, Lianyungang No 1 People's Hospital, Lianyungang, China
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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2
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Vinke JSJ, Ziengs AL, Buunk AM, van Sonderen L, Gomes-Neto AW, Berger SP, Bakker SJL, Eisenga MF, Spikman JM, De Borst MH. Iron deficiency and cognitive functioning in kidney transplant recipients: findings of the TransplantLines biobank and cohort study. Nephrol Dial Transplant 2023; 38:1719-1728. [PMID: 36662046 PMCID: PMC10310504 DOI: 10.1093/ndt/gfad013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Neurocognitive impairment is common in kidney transplant recipients (KTRs). Adequate brain functioning requires energy and neurotransmitter activity, for which iron is essential. We aimed to investigate iron deficiency (ID) as a potentially modifiable risk factor for cognitive impairment in KTRs. METHODS We analyzed stable KTRs participating in the TransplantLines Biobank and Cohort study. Participants underwent neuropsychological tests for memory, mental speed, and attention and executive functioning. ID was defined as ferritin <100 µg/mL or 100-299 µg/mL with transferrin saturation (TSAT) ≤20%. Associations between iron status and norm scores of neurocognitive outcomes, corrected for age, sex and education, were assessed using multivariable linear regression analyses adjusted for potential confounders including hemoglobin. RESULTS We included 166 KTRs [median (IQR) age 57 (45-65) years, 59% male, estimated glomerular filtration rate 51±18 mL/min/1.73 m2]. Time since transplantation was 5.8 (1.0-12.0) years. Prevalence of ID was 65%. ID was independently associated with lower scores for mental speed (std.β = -0.19, P = .02) and attention and executive functioning (std.β = -0.19, P = .02), and tended to be associated with worse memory (std.β = -0.16, P = .07). Lower plasma ferritin levels were associated with worse memory (std.β = 0.23, P = .007), mental speed (std.β = 0.34, P < .001), and attention and executive functioning (std.β = 0.30, P = .001). Lower TSAT was associated with worse memory (std.β = 0.19, P = .04) and mental speed (std.β = 0.27, P = .003), and tended to be associated with worse attention and executive functioning (std.β = 0.16, P = .08). CONCLUSIONS Iron-deficient KTRs performed worse on neurocognitive tasks measuring memory, mental speed, and attention and executive functioning. These findings set the stage for prospective studies addressing whether ID correction restores cognitive function after kidney transplantation.
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Affiliation(s)
- Joanna Sophia J Vinke
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Aaltje L Ziengs
- Department of Neuropsychology, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne M Buunk
- Department of Neuropsychology, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisanne van Sonderen
- Department of Neuropsychology, University Medical Center Groningen, Groningen, The Netherlands
| | - Antonio W Gomes-Neto
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - TransplantLines Investigators
- Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Michele F Eisenga
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacoba M Spikman
- Department of Neuropsychology, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin H De Borst
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
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Park KM, Heo CM, Lee DA, Lee YJ, Park S, Kim YW, Park BS. The effects of hemodialysis on the functional brain connectivity in patients with end-stage renal disease with functional near-infrared spectroscopy. Sci Rep 2023; 13:5691. [PMID: 37029163 PMCID: PMC10082020 DOI: 10.1038/s41598-023-32696-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023] Open
Abstract
This study aimed to investigate functional brain connectivity in patients with end-stage renal disease (ESRD) undergoing hemodialysis using functional near-infrared spectroscopy (fNIRS) and to analyze the effect of hemodialysis on functional brain connectivity. We prospectively enrolled patients with ESRD undergoing hemodialysis for > 6 months without any history of neurological or psychiatric disorders. fNIRS data were acquired using a NIRSIT Lite device. Measurements were performed thrice in the resting state for each patient: before the start of hemodialysis (pre-HD), 1 h after the start of hemodialysis (mid-HD), and after the end of hemodialysis (post-HD). We processed and exported all data, and created a weighted connectivity matrix using Pearson correlation analysis. We obtained functional connectivity measures from the connectivity matrix by applying a graph theoretical analysis. We then compared differences in functional connectivity measures according to hemodialysis status in patients with ESRD. We included 34 patients with ESRD. There were significant changes in the mean clustering coefficient, transitivity, and assortative coefficient between the pre- and post-HD periods (0.353 vs. 0.399, p = 0.047; 0.523 vs. 0.600, p = 0.042; and 0.043 vs. - 0.012, p = 0.044, respectively). However, there were no changes in the mean clustering coefficient, transitivity, and assortative coefficient between the pre- and mid-HD periods, or between the mid- and post-HD periods. In addition, there were no significant differences in the average strength, global efficiency, and local efficiency among the pre-, mid-, and post-HD periods. We demonstrated a significant effect of hemodialysis on functional brain connectivity in patients with ESRD. Functional brain connectivity changes more efficiently during hemodialysis.
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Affiliation(s)
- Kang Min Park
- Department of Neurology, Inje University College of Medicine, Busan, Korea
| | - Chang Min Heo
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, Korea
| | - Dong Ah Lee
- Department of Neurology, Inje University College of Medicine, Busan, Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, Korea
| | - Sihyung Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, Korea
| | - Yang Wook Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, Korea
| | - Bong Soo Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, Korea.
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4
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Zhang D, Chen Y, Shen J, Xie Q, Jing L, Lin L, Wang Q, Wu J. Static and Dynamic Characteristics of Functional Network Connectivity in Neurologically Asymptomatic Patients Undergoing Maintenance Hemodialysis: A Resting-State Functional MRI Study. J Magn Reson Imaging 2023; 57:420-431. [PMID: 35762494 PMCID: PMC10084323 DOI: 10.1002/jmri.28317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The characteristics of static functional network connectivity (sFNC) and dynamic FNC (dFNC) in neurologically asymptomatic patients undergoing maintenance hemodialysis are unknown. Elucidating these characteristics may improve our understanding of the mechanisms of neuropathological damage in these patients. PURPOSE To explore the static and dynamic characteristics of FNC in neurologically asymptomatic patients undergoing maintenance hemodialysis and the relationship between FNC-related parameters with the neuropsychological scores and blood biomarkers. STUDY TYPE Retrospective. POPULATION A total of 23 neurologically asymptomatic patients undergoing maintenance hemodialysis and 25 healthy controls matched for age, sex, and years of education. FIELD STRENGTH/SEQUENCE A 3.0 T MRI/functional MRI and three-dimensional-T1 structural imaging ASSESSMENT: Independent components; spatial map intensity; sFNC and dFNC strengths; and time attribute parameters (mean dwell time, fractional window, and number of transitions) were determined. Neuropsychological tests were performed. Blood biochemical tests were performed for the patients but not healthy controls. STATISTICAL TESTS Chi-squared test, one-sample t-test, two-sample t-test, partial correlation analysis, and family-wise error and false discovery rate correction. P < 0.05 denoted statistical significance. RESULTS Significant group differences in the strengths of sFNC and dFNC between networks were found. The sFNC strength between the visual and sensorimotor networks was significantly associated with the global cognitive function score (i.e. the Montreal Cognitive Assessment [MoCA]) (r = 0.606). The sFNC strength between the salience and default mode networks was significantly associated with anxiety scores (r = 0.458). In state 1, positive correlations were found between the mean dwell time and backward digital span task score (r = 0.562), fractional window and MoCA score (r = 0.576), and fractional window and backward digital span task score (r = 0.592). DATA CONCLUSION Neurologically asymptomatic patients undergoing maintenance hemodialysis had defective sFNC and dFNC. Our results provide a new perspective on the mechanism of neuropathological damage in patients undergoing maintenance hemodialysis. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Die Zhang
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China.,Department of Radiology, Shenzhen Third People's Hospital, Longgang District, Shenzhen, Guangdong, People's Republic of China
| | - Yingying Chen
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China.,Department of Radiology, National Cancer Centre, National Clinical Research Centre for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shenzhen, People's Republic of China
| | - Jing Shen
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Qing Xie
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Li Jing
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Lin Lin
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Qiong Wang
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China
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Peng C, Ran Q, Liu CX, Zhang L, Yang H. The instant impact of a single hemodialysis session on brain morphological measurements in patients with end-stage renal disease. Front Hum Neurosci 2022; 16:967214. [PMID: 36082229 PMCID: PMC9445124 DOI: 10.3389/fnhum.2022.967214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the instant impact of hemodialysis (HD) on the cerebral morphological measurements of patients with end-stage renal disease (ESRD).Materials and methodsTwenty-five patients undergoing maintenance HD and twenty-eight age-, sex-, and education-matched healthy control (HC) were included. The HD group and HC group had 3D high-resolution structural magnetic resonance imaging (MRI) scans twice and once, respectively. Both groups underwent neuropsychologic tests. The morphological measurements of structural MRI were measured using CAT12 and these measures were compared among three groups. The relationship between morphological measures and clinical parameters and neuropsychological tests were investigated through multiple regression analysis.ResultsCompared to the HC group, the cortical thickness before HD significantly decreased in the bilateral temporal lobe and significantly decreased in the left superior temporal gyrus after HD. The cortical thickness significantly increased in the bilateral temporal lobe, frontal lobe and occipital lobe after HD compared to before HD. The sulcus depth in the bilateral insula, frontal lobe, and parietal lobe after HD significantly increased compared to before HD. No significant differences in sulcus depth between HD and HC were detected. After HD, the cortical thickness of the right parsopercularis was positively correlated with the number connection test-A. Cortical thickness in multiple regions were positively correlated with blood flow velocity and cortical thickness in the left parahippocampal gyrus was negatively correlated with ultrafiltration volume. Patients showed better performance in the digit symbol test and line tracing test after HD compared to before HD, but there were no significant differences in the comparison of neuropsychologic tests between patients and HC.ConclusionThe instant morphological changes were captured during a single hemodialysis in HD patients. There was an association between these instant changes in the brain and clinical parameters and neuropsychologic tests. This work implied the instant impact of a single hemodialysis impact on the brain in HD patients.
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Affiliation(s)
- Cong Peng
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Qian Ran
- Department of Radiology, Xinqiao Hospital, Chongqing, China
- Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium
| | - Cheng Xuan Liu
- Department of Nephrology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Ling Zhang
- Department of Nephrology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Hua Yang
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
- *Correspondence: Hua Yang,
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6
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Chen JB, Chang CC, Moi SH, Li LC. A Profile of Nanoparticle-Based Plasma Neurodegenerative Biomarkers for Cognitive Function Among Patients Undergoing Hemodialysis. Int J Gen Med 2022; 15:6115-6125. [PMID: 35846795 PMCID: PMC9286482 DOI: 10.2147/ijgm.s368987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/05/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose This study aimed to compare the plasma levels of nanoparticle-based neurodegenerative biomarkers between hemodialysis (HD) participants with grossly normal cognitive function and healthy controls. Patients and Methods A cohort of participants undergoing maintenance HD and healthy controls were enrolled for comparison between July and October 2021. The immunomagnetic reduction method was used to measure plasma neurodegenerative biomarkers Aβ1-40, Aβ1-42, tau protein, and neurofilament light chain (NfL). The clinical dementia rating (CDR) was used to evaluate cognitive function. A receiver operating characteristic curve was used to discriminate between HD participants and healthy controls. Results There were 52 and 18 participants in the HD and healthy control groups, respectively. The mean age of the HD participants was 62 years, and that of the healthy controls was 57 years. The mean HD vintage in the HD cohort was 11.8 years. HD participants demonstrated significantly higher plasma levels of Aβ1-42, tau protein, Aβ1-42 × tau, and NfL and Aβ1-42/Aβ1-40 ratio and significantly lower plasma Aβ1-40 levels than healthy controls. The measured plasma biomarkers could not discriminate between CDR0 and CDR0.5 HD participants. The area under the curve of the study biomarkers to discriminate HD participants from healthy controls ranged from 0.987 (Aβ1-42 × tau) to 0.889 (NfL). Conclusion The plasma levels of nanoparticle-based neurodegenerative biomarkers were higher in HD participants with grossly normal cognitive function than in healthy controls. These findings imply that neurodegenerative changes appear in HD participants. A profile of plasma neurodegenerative biomarkers could be considered a potential surrogate for evaluating long-term cognitive function in HD participants.
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Affiliation(s)
- Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Kaohsiung, 833, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Taoyuan, 330, Taiwan, Republic of China
| | - Chiung-Chih Chang
- College of Medicine, Chang Gung University, Taoyuan, 330, Taiwan, Republic of China.,Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Kaohsiung, 833, Taiwan, Republic of China
| | - Sin-Hua Moi
- Center of Cancer Program Development, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 833, Taiwan, Republic of China
| | - Lung-Chih Li
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Kaohsiung, 833, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Taoyuan, 330, Taiwan, Republic of China
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7
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Hemodialyzed Individuals' Left Spatial Attentional Bias Is Normalized Following Successful Kidney Transplantation. Cogn Behav Neurol 2022; 35:32-39. [PMID: 35239597 DOI: 10.1097/wnn.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Healthy people have a leftward spatial attentional bias, called pseudoneglect. Individuals with end-stage renal disease (ESRD) who are receiving hemodialysis often demonstrate an increase in their leftward spatial attentional bias. Whereas a successful kidney transplant often improves the cognitive functions of individuals who previously received hemodialysis, the effect of a kidney transplant on this abnormal allocation of spatial attention has not been investigated. OBJECTIVE To investigate the effects of kidney transplant on individuals who were being treated with dialysis and had an increase in their left spatial attentional bias. METHOD The performance of 20 hemodialyzed individuals with ESRD on the line bisection test was compared to that of 17 demographically matched individuals with ESRD, who had received a kidney transplant, and 23 demographically matched healthy controls (HC). RESULTS All of the participants exhibited a left spatial bias on the line bisection task. When compared with the HC, the hemodialyzed individuals demonstrated a significantly greater left spatial bias. There was, however, no difference in spatial bias between the HC and the individuals who had received a kidney transplant. CONCLUSION A successful kidney transplant can improve patients' abnormal leftward allocation of spatial attention. However, future studies are needed to better understand the mechanisms of this spatial attentional bias in hemodialyzed individuals and the normalization of bias following transplantation.
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Ma C, Jiang X, Ren Y, Gu G, Fu A, Wang C, Bai P, Zhou T, Qin S, Fu S. Fiber connectivity density mapping in end-stage renal disease patients: a preliminary study. Brain Imaging Behav 2022; 16:1314-1323. [PMID: 35000065 DOI: 10.1007/s11682-021-00604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/25/2022]
Abstract
Abnormal brain structural connectivity of end-stage renal disease(ESRD) is associated with cognitive impairment. However, the characteristics of cortical structural connectivity have not been investigated in ESRD patients. Here, we study structural connectivity of the entire cerebral cortex using a fiber connectivity density(FiCD) mapping method derived from diffusion tensor imaging(DTI) data of 25 ESRD patients and 20 healthy controls, and between-group differences were compared in a vertexwise manner. We also investigated the associations between these abnormal cortical connectivities and the clinical variables using Pearson correlation analysis and multifactor linear regression analysis. Our results demonstrated that the mean global FiCD value was significantly decreased in ESRD patients. Notably, FiCD values were significantly changed(decreased or increased) in certain cortical regions, which mainly involved the bilateral dorsolateral prefrontal cortex(DLPFC), inferior parietal cortex, lateral temporal cortex and middle occipital cortex. In ESRD patients, we found a trend of negative correlation between the increased FiCD values of bilateral middle frontal gyrus and serum creatinine, urea, parathyroid hormone(PTH) levels and dialysis duration. Only the white matter hyperintensity(WMH) scores were significantly negatively correlated with the global FiCD value in multifactor regression analysis. Our results suggested that ESRD patients exhibited extensive impaired cortical structural connectivity, which was related to the severity of WMHs. A compensation mechanism of cortical structural recombination may play a role in how the brain adapts to maintain optimal network function. Additionally, the serum creatinine, urea and PTH levels may be risk factors for brain structural network decompensation in ESRD patients.
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Affiliation(s)
- Chi Ma
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xinghai Jiang
- Center for Disease Control and Prevention, West Coast New District, Qingdao, Shandong, China
| | - Yande Ren
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Gaojie Gu
- College of Electronic Information Engineering, Shandong University of Science and Technology, Qingdao, Shandong, China
| | - Airong Fu
- Department of Cardiovascular Medicine, West Coast New District Central Hospital, Qingdao, Shangdong, China
| | - Chengjian Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Peirui Bai
- College of Electronic Information Engineering, Shandong University of Science and Technology, Qingdao, Shandong, China
| | - Tong Zhou
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shanshan Qin
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shengli Fu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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9
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Herrington JD, Hartung EA, Laney NC, Hooper SR, Furth SL. Decreased Neural Connectivity in the Default Mode Network Among Youth and Young Adults With Chronic Kidney Disease. Semin Nephrol 2021; 41:455-461. [PMID: 34916007 DOI: 10.1016/j.semnephrol.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
An increasing amount of literature has indicated that chronic kidney disease (CKD) is associated with cognitive deficits that increase with worsening disease severity. Although abnormalities in brain structure have been widely documented, few studies to date have examined the functioning of brain areas associated with the specific cognitive domains affected by CKD (namely, attention and executive functions). Furthermore, few studies have examined functional connectivity among CKD youth who are relatively early in the course of the disease. The present study used functional magnetic resonance imaging to examine the resting state connectivity in 67 youth with CKD (mean age, 17 y) and 58 age-matched healthy controls. Using seed-based multiple regression, decreased connectivity was observed within the anterior cingulate portion of the default mode network. In addition, decreased connectivity within the dorsolateral prefrontal cortex, paracingulate gyrus, and frontal pole were correlated significantly with disease severity. These data indicate that connectivity deficits in circuits implementing attentional processes may represent an early marker for cognitive decline in CKD.
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Affiliation(s)
- John D Herrington
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Child Psychiatry and Behavioral Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nina C Laney
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Stephen R Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina School-Chapel Hill, Chapel Hill, NC
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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10
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Chang TY, Wu HH, Li YJ, Liu HL, Yeh CH, Jian HS, Huang KL, Lee TH, Tian YC, Wu CW. Changes of Brain Functional Connectivity in End-Stage Renal Disease Patients Receiving Peritoneal Dialysis Without Cognitive Decline. Front Med (Lausanne) 2021; 8:734410. [PMID: 34901056 PMCID: PMC8652044 DOI: 10.3389/fmed.2021.734410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Functional connectivity detected by resting-state functional MRI (R-fMRI) helps to discover the subtle changes in brain activities. Patients with end-stage renal disease (ESRD) on hemodialysis (HD) have impaired brain networks. However, the functional changes of brain networks in patients with ESRD undergoing peritoneal dialysis (PD) have not been fully delineated, especially among those with preserved cognitive function. Therefore, it is worth knowing about the brain functional connectivity in patients with PD by using R-fMRI. Methods: This case-control study prospectively enrolled 19 patients with ESRD receiving PD and 24 age- and sex- matched controls. All participants without a history of cognitive decline received mini-mental status examination (MMSE) and brain 3-T R-fMRI. Comprehensive R-fMRI analyses included graph analysis for connectivity and seed-based correlation networks. Independent t-tests were used for comparing the graph parameters and connectivity networks between patients with PD and controls. Results: All subjects were cognitively intact (MMSE > 24). Whole-brain connectivity by graph analysis revealed significant differences between the two groups with decreased global efficiency (Eglob, p < 0.05), increased betweenness centrality (BC) (p < 0.01), and increased characteristic path length (L, p < 0.01) in patients with PD. The functional connections of the default-mode network (DMN), sensorimotor network (SMN), salience network (SN), and hippocampal network (HN) were impaired in patients with PD. Meanwhile, in DMN and SN, elevated connectivity was observed in certain brain regions of patients with PD. Conclusion: Patients with ESRD receiving PD had specific disruptions in functional connectivity. In graph analysis, Eglob, BC, and L showed significant connectivity changes compared to the controls. DMN and SN had the most prominent alterations among the observed networks, with both decreased and increased connectivity regions. Our study confirmed that significant changes in cerebral connections existed in cognitively intact patients with PD.
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Affiliation(s)
- Ting-Yu Chang
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Hsu Wu
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Jung Li
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hui-Shan Jian
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Kuo-Lun Huang
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Changwei W Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.,Brain and Consciousness Research Center, Shuang-Ho Hospital-Taipei Medical University, New Taipei, Taiwan
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11
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Cao J, Liu G, Li X, Yue Z, Ren J, Zhu W, Wu B. Dynamic functional connectivity changes in the triple networks and its association with cognitive impairment in hemodialysis patients. Brain Behav 2021; 11:e2314. [PMID: 34333874 PMCID: PMC8413764 DOI: 10.1002/brb3.2314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/28/2021] [Accepted: 07/15/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Cognitive impairment is common in hemodialysis (HD) patients; however, the underlying mechanisms have not been fully understood. The "triple-network model" that consists of the salience network (SN), central executive network (CEN), and default mode network (DMN) has been suggested to play an important role in various cognitive functions. However, dynamic functional connectivity (FC) alterations within the triple networks have not been investigated in HD patients. METHODS Sixty-six HD patients and 66 healthy controls (HCs) were included in this study. The triple networks were identified using a group spatial independent component analysis, and dynamic FC was analyzed using a sliding window approach and k-means clustering algorithm. Furthermore, we analyzed the relationships between altered dynamic FC parameters and clinical variables in HD patients. RESULTS The intrinsic brain FC within the triple networks was clustered into four configuration states. Compared with HCs, HD patients spent more time in State 1, which was characterized by weak connections between the DMN and CEN and SN. HD patients showed lower number of transitions across different states than HCs. Moreover, the number of transitions and mean dwell time in State 1 were associated with cognitive performance in HD patients. CONCLUSION Our findings suggest abnormal dynamic FC properties within the triple networks in HD patients, which may provide new insights into the pathophysiological mechanisms of their cognitive deficits from the perspective of dynamic FC.
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Affiliation(s)
- Jianghui Cao
- Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Guangzhi Liu
- Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Xuekun Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Zheng Yue
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Jipeng Ren
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Wei Zhu
- Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Baolin Wu
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
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12
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Huang J, Xie L, Guo R, Wang J, Lin J, Sun Z, Duan S, Lin Z, Li H, Ma S. Abnormal brain activity patterns during spatial working memory task in patients with end-stage renal disease on maintenance hemodialysis: a fMRI study. Brain Imaging Behav 2021; 15:1898-1911. [PMID: 32996012 PMCID: PMC8413196 DOI: 10.1007/s11682-020-00383-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hemodialysis (HD) is associated with cognitive impairment in patients with end-stage renal disease (ESRD). However, the neural mechanism of spatial working memory (SWM) impairment in HD-ESRD patients remains unclear. We investigated the abnormal alterations in SWM-associated brain activity patterns in HD-ESRD patients using blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) technique during n-back tasks. Twenty-two HD-ESRD patients and 22 well-matched controls underwent an fMRI scan while undergoing a three-load n-back tasks with different difficulty levels. Cognitive and mental states were assessed using a battery of neuropsychologic tests. The HD-ESRD patients exhibited worse memory abilities than controls. Compared with the control group, the HD-ESRD patient group showed lower accuracy and longer response time under the n-back tasks, especially in the 2-back task. The patterns of brain activation changed under different working memory loads in the HD-ESRD patients, showing decreased activity in the right medial frontal gyrus and inferior frontal gyrus under 0-back and 1-back task, while more decreased activation in the bilateral frontal cortex, parietal lobule, anterior/posterior cingulate cortex and insula cortex under 2-back task. With the increase of task difficulty, the activation degree of the frontal and parietal cortex decreased. More importantly, we found that lower activation in frontal cortex and parietal lobule was associated with worse cognitive function in the HD-ESRD patients. These results demonstrate that the abnormal brain activity patterns of frontal cortex and parietal lobule may reflect the neural mediation of SWM impairment.
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Affiliation(s)
- Jinzhuang Huang
- Department of Radiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
- Shantou University Medical College, Shantou, 515041, Guangdong, China
- Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, 515041, China
| | - Lei Xie
- Department of Radiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China.
- Shantou University Medical College, Shantou, 515041, Guangdong, China.
- Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, 515041, China.
| | - Ruiwei Guo
- Department of Radiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
- Shantou University Medical College, Shantou, 515041, Guangdong, China
- Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, 515041, China
| | - Jinhong Wang
- Department of Ultrasound, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Jinquan Lin
- Department of Radiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Zongbo Sun
- Department of Radiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
- Shantou University Medical College, Shantou, 515041, Guangdong, China
- Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, 515041, China
| | - Shouxing Duan
- Department of Pediatric Surgery, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Zhirong Lin
- Department of Radiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Hui Li
- Mental Health Center, Shantou University Medical College, Shantou, 515000, China
| | - Shuhua Ma
- Department of Radiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China.
- Shantou University Medical College, Shantou, 515041, Guangdong, China.
- Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, 515041, China.
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13
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Abnormal degree centrality in end-stage renal disease (ESRD) patients with cognitive impairment: a resting-state functional MRI study. Brain Imaging Behav 2021; 15:1170-1180. [PMID: 32902798 DOI: 10.1007/s11682-020-00317-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To investigate functional connectivity (FC) changes in end-stage renal disease (ESRD) patients with and without cognitive impairment (CI) by using resting-state functional magnetic resonance imaging (rs-fMRI). Twenty-three ESRD patients with CI, 22 ESRD patients with non-CI (NCI) and 23 matched healthy controls (HC) were included. Rs-fMRI scans were performed in all subjects. Full-range, long-range, and short-range FC defined voxel-wise based degree centrality (DC) and seed based FC were computed and contrasted among the groups. Compared with HC, the DC value of short functional connectivity (SFC), in ESRD patients have increased on the left supramarginal gyrus, while it reduced on the left insula and right postcentral gyrus in CI and decreased on the right precentral gyrus in NCI. Compared with NCI, the DC value of LFC in CI increased on the left fusiform gyrus, while the DC value of short functional connectivity (SFC) increased on the left middle orbital gyrus. In the seed-based FC analyses, the CI showed significantly decreased FC between the left insula and bilateral middle temporal gyrus, between the left fusiform gyrus and the right hippocampus, and between the left postcentral gyrus and the right parahippocampus compared to HC; the CI showed significantly increased FC between the left precuneus and the left fusiform gyrus, between the left postcentral gyrus and the right precuneus compared with NCI. Positive correlations were found between DC values on the right superior frontal gyrus and LDL and BDST, and between MoCA and the DC values on the left insula and the left postcentral gyrus. The altered degree centrality may serve as early biomarkers for CI in ESRD patients.
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14
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Lee YJ, Yoon E, Park S, Kim YW, Kim SE, Ko J, Park JH, Park KM, Kim IH, Park BS. Alteration of brain connectivity in neurologically asymptomatic patients with chronic kidney disease. Medicine (Baltimore) 2021; 100:e25633. [PMID: 33879740 PMCID: PMC8078245 DOI: 10.1097/md.0000000000025633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
Our previous study demonstrated that patients with end-stage renal disease had decreased structural and functional brain connectivity, and there was a significant association between brain connectivity and cognitive function. The aim of this study was to evaluate the alterations of structural and functional connectivity using graph theoretical analysis in neurologically asymptomatic patients with relatively early-stage chronic kidney disease (CKD).We enrolled 18 neurologically asymptomatic patients with early CKD and 28 healthy controls. All the subjects underwent diffusion-tension imaging and resting functional magnetic resonance imaging. We calculated structural and functional connectivity based on diffusion-tension imaging and resting functional magnetic resonance imaging using a graph theoretical analysis. Then, we investigated differences of structural and functional connectivity between the CKD patients and the healthy controls.All the measures of structural connectivity were significantly different between the patients with CKD and healthy controls. The global efficiency, local efficiency, mean clustering coefficient, and small-worldness index were decreased, whereas the characteristic path length was increased in the patients with CKD compared with healthy controls. The structural betweenness centrality of the left calcarine and right posterior cingulum was also significantly different from that in healthy participants. However, all the measures of global functional connectivity in patients with CKD were not different from those in healthy controls. In patients with CKD, the functional betweenness centrality of the right insular cortex, right occipital pole, and right thalamus was significantly different from that in healthy participants.There are significant alterations of the global structural connectivity between the patients with CKD and the healthy subjects, whereas the global functional connectivity of the brain network is preserved. We find that the efficiency of the structural brain network is decreased in the patients with CKD.
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Affiliation(s)
| | | | | | | | - Si Eun Kim
- Department of Neurology, Inje University Haeundae Paik Hospital, Busan, Korea
| | | | | | - Kang Min Park
- Department of Neurology, Inje University Haeundae Paik Hospital, Busan, Korea
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15
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Yue Z, Wang P, Li X, Ren J, Wu B. Abnormal brain functional networks in end-stage renal disease patients with cognitive impairment. Brain Behav 2021; 11:e02076. [PMID: 33605530 PMCID: PMC8035483 DOI: 10.1002/brb3.2076] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Cognitive impairment (CI) is common in patients with end-stage renal disease (ESRD). Neuroimaging studies have demonstrated structural and functional brain alterations underlying CI in patients with ESRD. However, the patterns of change in whole-brain functional networks in ESRD patients with CI remain poorly understood. METHODS We enrolled 66 patients with ESRD (36 patients with CI and 30 patients without CI) and 48 healthy control subjects (HCs). We calculated the topological properties using a graph theoretical analysis. An analysis of covariance (ANCOVA) was used to compare network metrics among the three groups. Moreover, we analyzed the relationships between altered network measures and clinical variables in ESRD patients with CI. RESULTS Compared with HCs, both patient groups showed lower local efficiency and small-worldness. ESRD patients had decreased nodal centralities in the default mode regions and right amygdala. Comparison of the two patient groups showed significantly decreased global (small-worldness) and nodal (nodal centralities in the default mode regions) properties in the CI group. Altered nodal centralities in the bilateral medial part of the superior frontal gyrus, left posterior cingulate gyrus, and right precuneus were associated with cognitive performance in the CI group. CONCLUSION Disrupted brain functional networks were demonstrated in patients with ESRD, which were more severe in those with CI. Moreover, impaired nodal centralities in the default mode regions might underlie CI in patients with ESRD.
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Affiliation(s)
- Zheng Yue
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Pengming Wang
- Department of Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Xuekun Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Jipeng Ren
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Baolin Wu
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China.,Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
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16
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Hu R, Gao L, Chen P, Wu B, Wu X, Xu H. How Do You Feel Now? The Salience Network Functional Connectivity in End-Stage Renal Disease. Front Neurosci 2020; 14:533910. [PMID: 33304233 PMCID: PMC7693456 DOI: 10.3389/fnins.2020.533910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Objective The network connectivity basis of cognitive declines in end-stage renal disease (ESRD) remains unclear. A triple-network model of the salience (SN), executive control, and default mode networks has been suggested to be critical for efficient cognition. Here, we aimed to test the hypothesis that SN may play a role in cognitive impairment in patients with ESRD. Materials and Methods We investigated functional connectivity (FC) alterations within the SN between 43 ESRD patients (19 females/24 males, 46 ± 10 years) and 43 healthy controls (HC) (19 females/24 males, 47 ± 10 years), and performed linear support vector machine (LSVM) analysis on significant FC pairs within the SN to discriminate the two groups, and tested the accuracy of the classifier. Association and mediation analyses were conducted among the significant FC pairs within the SN nodes, clinical indicators, and neuropsychological tests scores. Results We identified significant between-group FC pairs within the SN and fairly good classification efficiency with significant accuracy (72.09%, p < 0.001). We found that FC between the right supramarginal gyrus and right anterior insula (AISL) was positively correlated with MoCA (r = 0.4010, p = 0.008); FC between the dorsal anterior cingulate cortex (dACC) and left AISL was positively correlated with the level of hemoglobin (r = 0.4979, p < 0.001). Mediation analysis found that the indirect effect of hemoglobin on forward digit span test scores via the FC between the dACC and right AISL (p < 0.05). Conclusion Disrupted SN connectivity may help explain cognitive declines in ESRD patients and act as a potential early biomarker. Moreover, the SN connectivity may interact with anemia to promote cognitive impairment.
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Affiliation(s)
- Runyue Hu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Peina Chen
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Nephrology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Baolin Wu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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17
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Ma C, Tian F, Ma MG, Su HW, Fan JC, Li ZH, Ren YD. Preferentially Disrupted Core Hubs Within the Default-Mode Network in Patients With End-Stage Renal Disease: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurol 2020; 11:1032. [PMID: 33250836 PMCID: PMC7674924 DOI: 10.3389/fneur.2020.01032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/07/2020] [Indexed: 01/25/2023] Open
Abstract
Neuroimaging evidence implies that cognitive impairment in patients with end-stage renal disease (ESRD) is related to the disruption of the default-mode network (DMN). The DMN can be divided into three functionally independent subsystems, which include the cortical hub subsystem [consisting of the posterior cingulate cortex (PCC) and the anterior medial prefrontal cortex (aMPFC)], the dorsal medial prefrontal cortex (dMPFC) subsystem, and the medial temporal lobe (MTL) subsystem. However, it is unknown how the functional connectivity (FC) in DMN subsystems is differentially impaired in ESRD. This prospective study was carried out at the Affiliated Hospital of Qingdao University, China, between August 2018 and July 2020. Thirty-two ESRD patients and forty-five healthy controls (HCs) were recruited for this study and received resting-state functional magnetic resonance imaging (rs-fMRI) scanning, and FCs on predefined regions of interest (ROIs) were individually calculated in three DMN subsystems using both ROI- and seed-based FC analyses to examine FC alterations within and between DMN subsystems. The two-sample t-test was used for the comparisons between groups. We also tested the associations between FC changes and clinical information using Pearson's correlation analysis. The results demonstrated that ESRD patients, compared with HCs, exhibit reduced FC specifically within the cortical hubs and between the DMN hubs and two subsystems (the dMPFC and MTL subsystems). Moreover, the FC values between the aMPFC and PCC were positively correlated with creatinine and urea levels in the ESRD patients. Our results suggest that the cortical hubs (PCC and aMPFC) are preferentially disrupted and that other subsystems may be progressively damaged to a certain degree as the disease develops.
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Affiliation(s)
- Chi Ma
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fen Tian
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Min-Ge Ma
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hua-Wei Su
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jian-Cong Fan
- College of Computer Science and Engineering, Shandong University of Science and Technology, Qingdao, China
| | - Zhan-Hui Li
- College of Computer Science and Engineering, Shandong University of Science and Technology, Qingdao, China
| | - Yan-de Ren
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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18
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Wu B, Li X, Zhang M, Zhang F, Long X, Gong Q, Jia Z. Disrupted brain functional networks in patients with end-stage renal disease undergoing hemodialysis. J Neurosci Res 2020; 98:2566-2578. [PMID: 32930417 DOI: 10.1002/jnr.24725] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023]
Abstract
Patterns of change in whole-brain functional networks remain poorly understood in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). We conducted a prospective research to investigate the topological properties of whole-brain functional networks in those patients using a graph-based network analysis. Resting-state functional magnetic resonance imaging was performed on 51 ESRD patients (25 HD and 26 nondialysis patients) and 36 healthy controls (HCs). We compared the topological properties of brain functional networks among the three groups, and analyzed the relationships between those significant parameters and clinical variables in ESRD patients. Progressively disrupted global topological organizations were observed from nondialysis patients to HD patients compared with HCs (all p < 0.05 after Bonferroni correction). HD patients, relative to HCs, showed significantly decreased nodal centralities in the left temporal pole: superior temporal gyrus, bilateral median cingulate and paracingulate gyri, bilateral hippocampus, bilateral parahippocampal gyrus, and bilateral amygdala, and showed increased nodal centralities in the orbital part of the bilateral middle frontal gyrus, left cuneus, and left superior occipital gyrus (all p < 0.05 after Bonferroni correction). Furthermore, nodal centralities in the bilateral hippocampus were significantly decreased in HD patients compared with nondialysis patients (p < 0.05 after Bonferroni correction). Dialysis duration negatively correlated with global efficiency in ESRD patients undergoing HD (r = -0.676, FDR q = 0.004). This study indicates that ESRD patients exhibit disruptions in brain functional networks, which are more severe in HD patients, and these alterations are correlated with cognitive performance and clinical markers.
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Affiliation(s)
- Baolin Wu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China.,Department of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui, PR China
| | - Xuekun Li
- Department of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui, PR China
| | - Meng Zhang
- Department of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui, PR China
| | - Feifei Zhang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Xipeng Long
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China.,Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, PR China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences (2018RU011), Chengdu, PR China
| | - Zhiyun Jia
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China.,Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, PR China
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19
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Peng C, Yang H, Ran Q, Zhang L, Liu C, Fang Y, Liu Y, Cao Y, Liang R, Ren H, Hu Q, Mei X, Jiang Y, Luo T. Immediate Abnormal Intrinsic Brain Activity Patterns in Patients with End-stage Renal Disease During a Single Dialysis Session : Resting-state Functional MRI Study. Clin Neuroradiol 2020; 31:373-381. [PMID: 32601841 DOI: 10.1007/s00062-020-00915-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/12/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To investigate cerebral amplitude of low-frequency fluctuations (ALFF) changes during a single hemodialysis (HD) in end-stage renal disease (ESRD) patients who need maintenance HD. MATERIALS AND METHODS A total of 24 patients and 27 healthy subjects were included. The patients underwent neuropsychological tests and took twice resting-state fMRI (rs-fMRI) (before and after HD). Healthy group had one rs-fMRI. The zALFF based on rs-fMRI was calculated. Paired t and independent t test was applied to compare zALFF among groups. The associations between zALFF and duration of HD, ultrafiltration volume, and neuropsychological tests was calculated by partial correlation. RESULTS Compared to healthy group, patients before HD showed significant worse performances on digit symbol test (DST) and serial dotting test (SDT). Patients after HD performed DST better than before HD. The patients after HD showed higher zALFF in left putamen than before HD. Multiple regions of both HD groups showed significant lower zALFF than healthy group. The zALFF of left putamen of patients after HD was significant negative correlated with the ultrafiltration volume (R = -0.679). The zALFF in patients before HD exhibited significantly positive or negative correlations with DST and SDT in multiple regions. The zALFF of patients after HD significantly negative correlated with DST in right temporal, positive and negative correlated with ultrafiltration volume in right frontal, left putamen respectively. CONCLUSION ESRD patients showed changed spontaneous brain activity and cognitive impairments. After a single HD session, patients performed better in neuropsychological test, and spontaneous brain activity changed in left putamen. Ultrafiltration volume might be associated with activity of left putamen.
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Affiliation(s)
- Cong Peng
- Department of Radiology, First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, 400016, Chongqing, Yuzhong District, China.,Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Hua Yang
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Qian Ran
- Department of Radiology, Xin Qiao Hospital, Chongqing, China.,Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium
| | - Ling Zhang
- Department of Nephrology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Chengxuan Liu
- Department of Nephrology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yu Fang
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yingjiang Liu
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yi Cao
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Renrong Liang
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - He Ren
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Qinqin Hu
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Xiuting Mei
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yang Jiang
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Tianyou Luo
- Department of Radiology, First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, 400016, Chongqing, Yuzhong District, China.
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20
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Park BS, Kim SE, Lee HJ, Kim YW, Kim IH, Park JH, Park SH, Lee YJ, Seo SA, Park KM. Alterations in Structural and Functional Connectivities in Patients with End-Stage Renal Disease. J Clin Neurol 2020; 16:390-400. [PMID: 32657059 PMCID: PMC7354985 DOI: 10.3988/jcn.2020.16.3.390] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose The aim of this study was to evaluate the structural and functional connectivities of brain network using graph theoretical analysis in neurologically asymptomatic patients with end-stage renal disease (ESRD). We further investigated the prevalence of cognitive impairment (CI) in ESRD patients and analyzed the association between network measures of brain connectivity and cognitive function. Methods We prospectively enrolled 40 neurologically asymptomatic ESRD patients, 40 healthy controls, and 20 disease controls. All of the subjects underwent diffusion-tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI). We calculated measures of structural and functional connectivities based on DTI and rs-fMRI, respectively, and investigated differences therein between the ESRD patients and the healthy controls. We assessed cognitive function in the ESRD patients using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery. Results The ESRD patients exhibited decreased global structural and functional brain connectivities, as well as alterations of network hubs compared to the healthy controls and disease controls. About 70% of the ESRD patients had CI. Moreover, ESRD patients without CI exhibited decreased global connectivity and alterations of network hubs. Furthermore, there was a significant positive association between measures of brain connectivity and cognitive function. Conclusions We found that ESRD patients exhibited decreased structural and functional brain connectivities, and that there was a significant association between brain connectivity and cognitive function. These alterations in the brain network may contribute to the pathophysiological mechanism of CI in ESRD patients.
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Affiliation(s)
- Bong Soo Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Si Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ho Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yang Wook Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Il Hwan Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Han Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Si Hyung Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sol A Seo
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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Lu H, Gu Z, Xing W, Han S, Wu J, Zhou H, Ding J, Zhang J. Alterations of default mode functional connectivity in individuals with end-stage renal disease and mild cognitive impairment. BMC Nephrol 2019; 20:246. [PMID: 31277581 PMCID: PMC6612101 DOI: 10.1186/s12882-019-1435-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 06/24/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) occurs frequently in many end stage renal disease (ESRD) patients, may significantly worsen survival odds and prognosis. However, the exact neuropathological mechanisms of MCI combined with ESRD are not fully clear. This study examined functional connectivity (FC) alterations of the default-mode network (DMN) in individuals with ESRD and MCI. METHODS Twenty-four individuals with ESRD identified as MCI patients were included in this study; of these, 19 and 5 underwent hemodialysis (HD) and peritoneal dialysis (PD), respectively. Another group of 25 age-, sex- and education level-matched subjects were recruited as the control group. All participants underwent resting-state functional MRI and neuropsychological tests; the ESRD group underwent additional laboratory testing. Independent component analysis (ICA) was used for DMN characterization. With functional connectivity maps of the DMN derived individually, group comparison was performed with voxel-wise independent samples t-test, and connectivity changes were correlated with neuropsychological and clinical variables. RESULTS Compared with the control group, significantly decreased functional connectivity of the DMN was observed in the posterior cingulate cortex (PCC) and precuneus (Pcu), as well as in the medial prefrontal cortex (MPFC) in the ESRD group. Functional connectivity reductions in the MPFC and PCC/Pcu were positively correlated with hemoglobin levels. In addition, functional connectivity reduction in the MPFC showed positive correlation with Montreal Cognitive Assessment (MoCA) score. CONCLUSION Decreased functional connectivity in the DMN may be associated with neuropathological mechanisms involved in ESRD and MCI.
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Affiliation(s)
- Haitao Lu
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhengzhang Gu
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wei Xing
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China.
| | - Shanhua Han
- Department of Radiology, Shanghai Fourth People's Hospital, Shanghai, China
| | | | - Hua Zhou
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jiule Ding
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jinggang Zhang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Deteriorated functional and structural brain networks and normally appearing functional–structural coupling in diabetic kidney disease: a graph theory-based magnetic resonance imaging study. Eur Radiol 2019; 29:5577-5589. [DOI: 10.1007/s00330-019-06164-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/18/2019] [Accepted: 03/14/2019] [Indexed: 01/25/2023]
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Cheng BC, Chen PC, Chen PC, Lu CH, Huang YC, Chou KH, Li SH, Lin AN, Lin WC. Decreased cerebral blood flow and improved cognitive function in patients with end-stage renal disease after peritoneal dialysis: An arterial spin-labelling study. Eur Radiol 2019; 29:1415-1424. [PMID: 30105409 PMCID: PMC6510858 DOI: 10.1007/s00330-018-5675-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/06/2018] [Accepted: 07/17/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the relationship between cognitive impairment and brain perfusion using arterial spin labelling (ASL) in end-stage renal disease (ESRD) patients undergoing PD. METHODS ESRD patients undergoing PD were recruited. Laboratory screening, neuropsychological tests and ASL magnetic resonance imaging (MRI) were conducted prior to and after 6 months of PD. Age- and sex-matched normal subjects without ESRD served as the control group. Comparisons of regional CBF between ESRD patients before or after undergoing PD and normal controls were performed. Correlations between biochemical, neuropsychological and CBF data were also conducted to evaluate the relationships. RESULTS ESRD patients showed poor performance in many of the neuropsychological tests; PD improved cognition in some domains. Pre-PD patients had higher mean CBF than post-PD patients and normal controls, but no significant difference was found between the normal controls and post-PD patients. Negative correlations were observed pre-PD (regional CBF in left hippocampus vs. perseverative responses, r = -0.662, p = 0.014), post-PD (mean CBF vs. haemoglobin level, r = -0.766, p = 0.002), and before and after PD (change in CBF in the left putamen vs. change in haematocrit percentage, r = -0.808, p = 0.001). CONCLUSION Before PD, ESRD patients had increased cerebral perfusion that was related to poorer executive function, especially in the left hippocampus. Post-PD patients performed better in some cognitive test domains than pre-PD patients. The degree of anaemia, i.e., haemoglobin level or haematocrit percentage, might predict cognitive impairment in PD patients. KEY POINTS • In this study, ESRD patients before PD had cerebral hyperperfusion that was related to poorer executive function. • Post-PD patients performed better in some cognitive test domains than pre-PD patients did. • The degree of anaemia might predict cognitive impairment in PD patients.
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Affiliation(s)
- Ben-Chung Cheng
- Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Pei-Chin Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Kun-Hsien Chou
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Shau-Hsuan Li
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan.
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Li A, Mu J, Huang M, Zhang Z, Liu J, Zhang M. Altered amygdala-related structural covariance and resting-state functional connectivity in end-stage renal disease patients. Metab Brain Dis 2018; 33:1471-1481. [PMID: 29869149 DOI: 10.1007/s11011-018-0254-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 05/21/2018] [Indexed: 02/07/2023]
Abstract
Depression and cognitive control deficits were frequently reported in concurrent end-stage renal disease (ESRD) patients. Neuroimaging studies indicated depression could be a risk factor for cognitive control deficits, and amygdala-related circuitry may play a critical role in this abnormal interaction. To investigate the potential relationship between depressive symptoms and cognitive control reduction in ESRD patients, T1-weighted and resting fMRI images were obtained in 29 ESRD patients and 29 healthy controls. Voxel-based morphometry (VBM), structural covariance (SC) analysis based on grey matter volume (GMV), and functional connectivity (FC) analysis were adopted. All subjects performed the Beck Depression Inventory (BDI) assessment and Stroop test. The patients also underwent blood biochemistry tests (urea, creatinine, phosphate, Ca2+, hematocrit, cystatin, hemoglobin). Compared with controls, GMV reductions were found mainly in the anterior cingulate cortex (ACC) and bilateral amygdala, and decreased SC was found between the amygdala and ACC in ESRD patients. This indicated that structural changes in the amygdala may be related to the GMV alterations in the ACC. Additionally, decreased FC between the amygdala and ACC was revealed in ESRD patients. Negative correlation was found between the FC of the amygdala-ACC and reaction delay during the Stroop test, but this correlation disappeared after controlling BDI. Stepwise regression analysis showed that the low level of hemoglobin was contributed to the reduced FC of the amygdala-ACC in ESRD patients. Our results demonstrated the abnormal interaction between depressive mood and cognitive control deficits in ESRD patients.
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Affiliation(s)
- Anmao Li
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China
- Xi'an Children's Hospital, Xi'an, 710061, People's Republic of China
| | - Junya Mu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, People's Republic of China
| | - Mingxia Huang
- Xi'an Children's Hospital, Xi'an, 710061, People's Republic of China
| | - Zengjun Zhang
- Xi'an Children's Hospital, Xi'an, 710061, People's Republic of China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China.
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, People's Republic of China.
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China.
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Leftward Bias of Visual Attention in Patients with End-Stage Renal Disease Receiving Dialysis: A Neglected Phenomenon. Cogn Behav Neurol 2017; 30:176-181. [DOI: 10.1097/wnn.0000000000000142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mu J, Chen T, Liu Q, Ding D, Ma X, Li P, Li A, Huang M, Zhang Z, Liu J, Zhang M. Abnormal interaction between cognitive control network and affective network in patients with end-stage renal disease. Brain Imaging Behav 2017; 12:1099-1111. [DOI: 10.1007/s11682-017-9782-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Disorders of the anterior attentional-intentional system in patients with end stage renal disease: Evidence from reaction time studies. Brain Cogn 2016; 107:1-9. [DOI: 10.1016/j.bandc.2016.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 11/18/2022]
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Michałowski JM, Harciarek M, Biedunkiewicz B, Williamson J, Dębska-Ślizień A, Rutkowski B, Heilman KM. Slowing with end-stage renal disease: Attentive but unprepared to act. Int J Psychophysiol 2016; 106:30-8. [DOI: 10.1016/j.ijpsycho.2016.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 11/17/2022]
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Jiang XL, Wen JQ, Zhang LJ, Zheng G, Li X, Zhang Z, Liu Y, Zheng LJ, Wu L, Chen HJ, Kong X, Luo S, Lu GM, Ji XM, Zhang ZJ. Cerebral blood flow changes in hemodialysis and peritoneal dialysis patients: an arterial-spin labeling MR imaging. Metab Brain Dis 2016; 31:929-36. [PMID: 27167984 DOI: 10.1007/s11011-016-9829-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 04/28/2016] [Indexed: 01/04/2023]
Abstract
We used arterial-spin labeling (ASL) MR imaging, a non-invasive technique to evaluate cerebral blood flow (CBF) changes in patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) and hemodialysis (HD), and nondialysis ESRD patients compared with healthy cohort. Ninety seven ESRD patients including 32 PD patients (20 male, 12 female; mean age 33 ± 8 years), 33 HD patients (22 male, 11 female; mean age 33 ± 8 years) and 32 nondialysis patients (20 male, 12 female; mean age 35 ± 7 years) and 31 age- and gender-matched healthy controls (20 male, 11 female; mean age 32 ± 8 years) were included in this study. All subjects underwent ASL MR imaging, neuropsychologic tests, and ESRD patients underwent laboratory testing. CBF values were compared among PD, HD, nondialysis patients and control groups. Correlation analysis and multiple regression analysis were performed to investigate the association between CBF values and hemoglobin, neuropsychologic test results, serum creatinine, urea levels, disease duration, and dialysis duration. Elevated CBFs of whole brain region, gray matter, and white matter were found in all ESRD patient groups compared with healthy controls (all P < 0.001). However, compared with non-dialysis ESRD patients, both PD and HD patients had widespread regional CBF decline mainly in bilateral frontal and anterior cingulate cortices. There were no differences for CBF between PD and HD patient groups. Negative correlations were observed between mean CBFs of whole brain region, gray matter, and white matter and the hemoglobin level in all ESRD patients. Multiple linear regression showed elevated CBF of multiple brain areas correlated with some neuropsychological tests in ESRD patients (all P < 0.001, AlphaSim corrected), but the association was not present or shrank after adjusting hemoglobin level. This study found that mean CBF was predominantly increased in patients with ESRD, which correlated with their hemoglobin level and neurocognitive disorders. There were no differences of CBF change and cognitive function between PD and HD ESRD patients with long-term treatment. The degree of anemia may be a predominant risk factor for cognitive impairment in these ESRD patients.
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Affiliation(s)
- Xiao Lu Jiang
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Ji Qiu Wen
- National Clinical Research Center of Kidney Diseases, Jingling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Gang Zheng
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
- College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, 210016, China.
| | - Xue Li
- National Clinical Research Center of Kidney Diseases, Jingling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Zhe Zhang
- National Clinical Research Center of Kidney Diseases, Jingling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Ya Liu
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
- College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, 210016, China
| | - Li Juan Zheng
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Long Wu
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Hui Juan Chen
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Xiang Kong
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Song Luo
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China
| | - Xue Man Ji
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
| | - Zong Jun Zhang
- Department of Medical Imaging, Jingling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, 210002, China.
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Wang X, Wang Z, Liu J, Chen J, Liu X, Nie G, Byun JS, Liang Y, Park J, Huang R, Liu M, Liu B, Kong J. Repeated acupuncture treatments modulate amygdala resting state functional connectivity of depressive patients. Neuroimage Clin 2016; 12:746-752. [PMID: 27812501 PMCID: PMC5079358 DOI: 10.1016/j.nicl.2016.07.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 12/13/2022]
Abstract
As a widely-applied alternative therapy, acupuncture is gaining popularity in Western society. One challenge that remains, however, is incorporating it into mainstream medicine. One solution is to combine acupuncture with other conventional, mainstream treatments. In this study, we investigated the combination effect of acupuncture and the antidepressant fluoxetine, as well as its underlying mechanism using resting state functional connectivity (rsFC) in patients with major depressive disorders. Forty-six female depressed patients were randomized into a verum acupuncture plus fluoxetine or a sham acupuncture plus fluoxetine group for eight weeks. Resting-state fMRI data was collected before the first and last treatments. Results showed that compared with those in the sham acupuncture treatment, verum acupuncture treatment patients showed 1) greater clinical improvement as indicated by Montgomery-Åsberg Depression Rating Scale (MADRS) and Self-Rating Depression Scale (SDS) scores; 2) increased rsFC between the left amygdala and subgenual anterior cingulate cortex (sgACC)/preguenual anterior cingulate cortex (pgACC); 3) increased rsFC between the right amygdala and left parahippocampus (Para)/putamen (Pu). The strength of the amygdala-sgACC/pgACC rsFC was positively associated with corresponding clinical improvement (as indicated by a negative correlation with MADRS and SDS scores). Our findings demonstrate the additive effect of acupuncture to antidepressant treatment and suggest that this effect may be achieved through the limbic system, especially the amygdala and the ACC.
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Affiliation(s)
- Xiaoyun Wang
- Traditional Chinese Medicine Hospital of Guangdong province, Guangzhou 510120, China
| | - Zengjian Wang
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, Guangzhou 510631, China
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jian Liu
- Traditional Chinese Medicine Hospital of Guangdong province, Guangzhou 510120, China
| | - Jun Chen
- Traditional Chinese Medicine Hospital of Guangdong province, Guangzhou 510120, China
| | - Xian Liu
- Traditional Chinese Medicine Hospital of Guangdong province, Guangzhou 510120, China
| | - Guangning Nie
- Traditional Chinese Medicine Hospital of Guangdong province, Guangzhou 510120, China
| | - Joon-Seok Byun
- Department of Internal Medicine, College of Korean Medicine, Daegu Haany University, 165 Sang-dong, Suseong-gu, Daegu 706-828, Republic of Korea
| | - Yilin Liang
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Wellesley College, Wellesley, MA, USA
| | - Joel Park
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Ruiwang Huang
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Ming Liu
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Bo Liu
- Traditional Chinese Medicine Hospital of Guangdong province, Guangzhou 510120, China
| | - Jian Kong
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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Guensch DP, Nadeshalingam G, Fischer K, Stalder AF, Friedrich MG. The impact of hematocrit on oxygenation-sensitive cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2016; 18:42. [PMID: 27435406 PMCID: PMC4952059 DOI: 10.1186/s12968-016-0262-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oxygenation-sensitive (OS) Cardiovascular Magnetic Resonance (CMR) is a promising utility in the diagnosis of heart disease. Contrast in OS-CMR images is generated through deoxyhemoglobin in the tissue, which is negatively correlated with the signal intensity (SI). Thus, changing hematocrit levels may be a confounder in the interpretation of OS-CMR results. We hypothesized that hemodilution confounds the observed signal intensity in OS-CMR images. METHODS Venous and arterial blood from five pigs was diluted with lactated Ringer solution in 10 % increments to 50 %. The changes in signal intensity (SI) were compared to changes in blood gases and hemoglobin concentration. We performed an OS-CMR scan in 21 healthy volunteers using vasoactive breathing stimuli at baseline, which was then repeated after rapid infusion of 1 L of lactated Ringer's solution within 5-8 min. Changes of SI were measured and compared between the hydration states. RESULTS The % change in SI from baseline for arterial (r = -0.67, p < 0.0001) and venous blood (r = -0.55, p = 0.002) were negatively correlated with the changes in hemoglobin (Hb). SI changes in venous blood were also associated with SO2 (r = 0.68, p < 0.0001) and deoxyHb concentration (-0.65, p < 0.0001). In healthy volunteers, rapid infusion resulted in a significant drop in the hemoglobin concentration (142.5 ± 15.2 g/L vs. 128.8 ± 15.2 g/L; p < 0.0001). Baseline myocardial SI increased by 3.0 ± 5.7 % (p = 0.026) following rapid infusion, and in males there was a strong association between the change in hemoglobin concentration and % changes in SI (r = 0.82, p = 0.002). After hyperhydration, the SI response after hyperventilation was attenuated (HV, p = 0.037), as was the maximum SI increase during apnea (p = 0.012). The extent of SI attenuation was correlated with the reduction in hemoglobin concentration at the end of apnea (r = 0.55, p = 0.012) for all subjects and at maximal SI (r = 0.63, p = 0.037) and the end of breath-hold (r = 0.68, p = 0.016) for males only. CONCLUSION In dynamic studies using oxygenation-sensitive CMR, the hematocrit level affects baseline signal intensity and the observed signal intensity response. Thus, the hydration status of the patient may be a confounder for OS-CMR image analysis.
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Affiliation(s)
- Dominik P. Guensch
- />Philippa & Marvin Carsley CMR Centre at the Montreal Heart Institute, Montreal, QC Canada
- />Department of Anesthesiology and Pain Therapy, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
- />Instutite of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gobinath Nadeshalingam
- />Philippa & Marvin Carsley CMR Centre at the Montreal Heart Institute, Montreal, QC Canada
| | - Kady Fischer
- />Philippa & Marvin Carsley CMR Centre at the Montreal Heart Institute, Montreal, QC Canada
- />Department of Anesthesiology and Pain Therapy, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | | | - Matthias G. Friedrich
- />Philippa & Marvin Carsley CMR Centre at the Montreal Heart Institute, Montreal, QC Canada
- />Department of Medicine, Heidelberg University, Heidelberg, Germany
- />Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, AB Canada
- />Department of Radiology, Université de Montréal, Montreal, QC Canada
- />Departments of Medicine and Radiology, McGill University Health Centre, Montreal, QC Canada
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Zhang XD, Wen JQ, Xu Q, Qi R, Chen HJ, Kong X, Wei LD, Xu M, Zhang LJ, Lu GM. Altered long- and short-range functional connectivity in the patients with end-stage renal disease: a resting-state functional MRI study. Metab Brain Dis 2015; 30:1175-86. [PMID: 26016622 DOI: 10.1007/s11011-015-9683-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/11/2015] [Indexed: 01/10/2023]
Abstract
To investigate alterations of functional connectivity density (FCD) in patients with end-stage renal disease (ESRD) by using resting-state functional magnetic resonance imaging (rs-fMRI). Medical research ethics committee approval from Jinling hospital and written informed consent from each subject were obtained. Forty six patients with ESRD, consisting of 21 patients minimal nephrotic encephalopathy (MNE) and 25 non-nephro-encephalopathy (non-NE), as well as 23 healthy controls underwent rs-fMRI. Neuropsychological tests were performed in all subjects, while laboratory tests were performed in ESRD patients. A voxel-wise whole brain functional connectivity analysis was used to generate long- and short-range FCD maps. The maps among MNE, non-NE, and healthy controls groups were compared by using one-way analysis of variance tests. A multiple regression analysis was performed to evaluate the correlations between FCD and the variables of neuropsychological or laboratory tests. Compared with healthy controls, non-NE showed decreased long-range FCD mainly in parietal lobe. Moreover, MNE showed further decreased long-range FCD in bilateral middle prefrontal cortex (MPFC), anterior cingulate cortex (ACC) and right superior frontal gyrus. Meanwhile, non-NE showed decreased short-range FCD mainly in frontal cortex, and further reduction in bilateral ACC and right superior parietal gyrus in MNE. In addition, patients with ESRD mainly exhibited increased long-range FCD in left temporal lobe and caudate; and increased short-range FCD in bilateral orbitofrontal cortex and temporal gyri (P < 0.05, AlphaSim corrected). The number connection test type A score, serum creatinine, urea, and dialysis duration showed negative correlation with FCD in some brain regions, while the digital symbol test scores positively correlated with short-range FCD in left inferior parietal lobule (all P < 0.05, AlphaSim corrected). The prominent long- and short-range FCD reduction was found mainly in default mode network (DMN) and bilateral frontal and parietal lobes, while the progressively decreased long- and short-range FCD in ACC/MPFC and the long-range FCD in left superior frontal gyrus from non-NE to MNE was associated with cognition dysfunction in ESRD patients.
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Affiliation(s)
- Xiao-Dong Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, Jiangsu Province, 210002, China
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Chen HJ, Qi R, Kong X, Wen J, Liang X, Zhang Z, Li X, Lu GM, Zhang LJ. The impact of hemodialysis on cognitive dysfunction in patients with end-stage renal disease: a resting-state functional MRI study. Metab Brain Dis 2015; 30:1247-56. [PMID: 26146033 DOI: 10.1007/s11011-015-9702-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/22/2015] [Indexed: 12/31/2022]
Abstract
To investigate the effect of hemodialysis (HD) on cognitive dysfunction in patients with end-stage renal disease (ESRD) using resting-state functional MR imaging (rs-fMRI) with regional homogeneity (ReHo) and functional connectivity algorithms. The rs-fMRI data were acquired in 58 ESRD patients (HD patients, n = 32, 22 male and 10 female, mean age 36.5 ± 9.6 years; non-HD ESRD patients, n = 26, 16 male and 10 female, mean years of 35.6 ± 8.2) and 32 healthy controls (22 male and 10 female, mean years of 32.7 ± 8.8). A battery of neuropsychological and blood laboratory tests were prescribed. The Kendall's coefficient of concordance (KCC) was used to measure ReHo for each subject. The ReHo maps were compared by using ANOVA tests among HD, non-HD, and healthy control groups. Regions showing ReHo differences between HD and non-HD patients were defined as seeds for further functional connectivity analysis. A multiple regression analysis was performed to evaluate the relationships between ReHo index and neuropsychological tests, serum creatinine and urea levels, disease and dialysis duration. Compared with healthy controls, both HD patients and non-HD patients showed decreased ReHo in the multiple areas of bilateral frontal, parietal and temporal lobes. Compared with the non-HD, HD patients showed decreased ReHo mainly in default mode network (DMN) including bilateral precuneus, posterior cingulate cortex, inferior parietal lobe, right postcentral gyrus, bilateral superior temporal gyri, right supramarginal gyrus and right angular gyrus. Some reduced ReHo brain regions correlated with some neuropsychological tests, serum creatinine and urea levels, and dialysis duration. Brain regions with ReHo reduction showed increased region-to-region functional network in HD patients compared with non-HD patients. Widespreadly decreased ReHo values were found in both HD and non-HD patients. Lower ReHo values mainly in the DMN correlated with cognition impairments were observed in HD patients compared with non-HD patients, while increased functional connectivity was found between these brain regions. HD might have an adverse effect on the cognitive function in ESRD patients.
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Affiliation(s)
- Hui Juan Chen
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
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Elevated global cerebral blood flow, oxygen extraction fraction and unchanged metabolic rate of oxygen in young adults with end-stage renal disease: an MRI study. Eur Radiol 2015; 26:1732-41. [PMID: 26334507 DOI: 10.1007/s00330-015-3968-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/15/2015] [Accepted: 08/05/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To noninvasively assess global cerebral blood flow (CBF), oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) in young adults with end-stage renal disease (ESRD). METHODS Thirty-six patients and 38 healthy volunteers were included and took part in MR examinations, blood and neuropsychological tests. CBF and OEF were measured by phase-contrast and T2-relaxation-under-spin-tagging MRI techniques, respectively. CMRO2 was computed from CBF, OEF and hematocrit according to Fick's principle. Correlations were performed between MR measurements, blood biochemistry measurements and neuropsychological test scores. RESULTS Compared with controls, ESRD patients had elevated CBF (72.9 ± 12.5 vs. 63.8 ± 8.5 ml min(-1) 100 g(-1), P < 0.001), elevated OEF (47.2 ± 10.2 vs. 35.8 ± 5.4 %, P < 0.001), but unaffected CMRO2 (199.5 ± 36.4 vs. 193.8 ± 28.6 μmol O2 min(-1) 100 g(-1), P = 0.879). Hematocrit negatively correlated with CBF (r = -0.640, P < 0.001) and OEF (r = -0.701, P < 0.001), but not with CMRO2. Altered neuropsychological test scores of ESRD patients were associated with OEF and CBF, but not with CMRO2. There were weak relationships between eGFR and hematocrit (r = 0.308, P = 0.068) or CBF (r = 0.318, P = 0.059). CONCLUSION Our findings suggested that anaemic young adults with ESRD may afford higher CBF and OEF to maintain a normal CMRO2. Despite this compensatory process, however, cognitive function was still impaired and its severity was correlated with their CBF and OEF abnormality. KEY POINTS • Anaemic young adults with ESRD may afford higher CBF and OEF. • Anaemic young adults with ESRD maintain a normal CMRO 2 . • Cognitive function was still impaired in young ESRD adults. • The severity of cognitive dysfunction correlated with CBF and OEF changes.
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Freudenreich O, Huffman JC, Sharpe M, Beach SR, Celano CM, Chwastiak LA, Cohen MA, Dickerman A, Fitz-Gerald MJ, Kontos N, Mittal L, Nejad SH, Niazi S, Novak M, Philbrick K, Rasimas JJ, Shim J, Simpson SA, Walker A, Walker J, Wichman CL, Zimbrean P, Söllner W, Stern TA. Updates in Psychosomatic Medicine: 2014. PSYCHOSOMATICS 2015; 56:445-59. [DOI: 10.1016/j.psym.2015.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 01/21/2023]
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Zhang LJ, Wen J, Liang X, Qi R, Schoepf UJ, Wichmann JL, Milliken CM, Chen HJ, Kong X, Lu GM. Brain Default Mode Network Changes after Renal Transplantation: A Diffusion-Tensor Imaging and Resting-State Functional MR Imaging Study. Radiology 2015. [PMID: 26200603 DOI: 10.1148/radiol.2015150004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate structural and functional alterations of the default mode network (DMN) in the brain after renal transplantation in patients with end-stage renal disease by using diffusion-tensor imaging and resting-state functional MR imaging. MATERIALS AND METHODS This prospective study was approved by the local medical research ethics committee, and written informed consent was obtained. Twenty-one patients with end-stage renal disease (15 men, six women; mean age ± standard deviation, 32 years ± 9.5) who were scheduled to undergo renal transplantation and 21 healthy control subjects (15 men, six women; mean age, 31 years ± 6.5) were included. Diffusion-tensor imaging and resting-state functional MR imaging were performed in all subjects. Patients were imaged both before and 1 month after renal transplantation. Structural (mean diffusivity, fractional anisotropy, path length, and number of tracts derived from diffusion-tensor imaging tractography) and functional (temporal correlation coefficient derived from resting-state functional MR imaging) connectivity of the DMN were quantitatively compared with two-sample t tests or paired t tests. Intergroup correlation analysis was performed to compare structural or functional indexes and results of neuropsychological or blood biochemistry tests. RESULTS Mean diffusivity was decreased in the fiber bundles connecting the posterior cingulate cortex and the precuneus to the bilateral inferior parietal lobules in patients after renal transplantation compared with that in patients before transplantation (P < .05). Temporal correlation coefficients for patients after renal transplantation nearly reached the levels of those for control subjects (all, P > .05). The change in mean diffusivity of the fiber bundles connecting the posterior cingulate cortex and the precuneus to the right inferior parietal lobule positively correlated with the change in hematocrit levels (r = 0.522, P = .015), the change in temporal correlation coefficients between the posterior cingulate cortex or precuneus and left or right inferior parietal lobules correlated with changes in number connection test type A scores (r = -0.549, P = .010) and digit symbol test scores (r = 0.533, P = .013). CONCLUSION Functional connectivity changes in the DMN, which were associated with improved hematocrit levels and cognitive function, may recover earlier than structural connectivity changes do 1 month after renal transplantation.
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Affiliation(s)
- Long Jiang Zhang
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Jiqiu Wen
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Xue Liang
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Rongfeng Qi
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - U Joseph Schoepf
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Julian L Wichmann
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Cole M Milliken
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Hui Juan Chen
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Xiang Kong
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
| | - Guang Ming Lu
- From the Department of Medical Imaging (L.J.Z., X.L., R.Q., H.J.C., X.K., G.M.L.) and National Clinical Research Center of Kidney Disease (J.W.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; and Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., J.L.W., C.M.M.)
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Abnormal degree centrality in neurologically asymptomatic patients with end-stage renal disease: A resting-state fMRI study. Clin Neurophysiol 2015; 127:602-609. [PMID: 26160274 DOI: 10.1016/j.clinph.2015.06.022] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 06/17/2015] [Accepted: 06/20/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE End-stage renal disease (ESRD), characterized by multi-organ dysfunction, has been shown to co-occur with abnormal brain function. Previous resting-state fMRI studies suggested that regional brain spontaneous activity and functional connectivity within the default mode network are abnormal in ESRD patients. The current study aimed to depict intrinsic dysconnectivity pattern of whole-brain functional networks in voxel level in neurologically asymptomatic patients with ESRD. METHODS fMRI datasets were acquired from 22 ESRD patients (without clinical neurological disease) and 29 healthy control (HC) subjects. We investigated the degree centrality for a given element in a network to reveal the changes of functional connectivity throughout the huge human functional network. In the brain regions showing a difference between the HC and ESRD groups, we further conducted receptive operation characteristic (ROC) analyses to confirm the accuracy, sensitivity and specificity of our results. RESULTS ESRD patients showed decreased functional connectivity in the left inferior parietal and left precuneus within the brain network; both regions are important components of the default-mode network (DMN). In contrast, patients showed increased connectivity in depression-related regions including bilateral inferior frontal gyrus and right superior temporal gyrus. These regions showed an acceptable accuracy (0.68-0.75), sensitivity (0.64-0.70) and high specificity (0.82-0.96) in distinguishing between the two groups. CONCLUSIONS Our findings reveal abnormal intrinsic dysconnectivity pattern of whole-brain functional networks in ESRD patients. SIGNIFICANCE Our results could lead to a better understanding of the intrinsic dysconnectivity patterns of default-mode network-related regions in ESRD patients from the whole brain network perspective.
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Luo S, Qi RF, Wen JQ, Zhong JH, Kong X, Liang X, Xu Q, Zheng G, Zhang Z, Zhang LJ, Lu GM. Abnormal Intrinsic Brain Activity Patterns in Patients with End-Stage Renal Disease Undergoing Peritoneal Dialysis: A Resting-State Functional MR Imaging Study. Radiology 2015; 278:181-9. [PMID: 26053309 DOI: 10.1148/radiol.2015141913] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To analyze the spontaneous brain activity patterns in patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) by using resting-state functional magnetic resonance (MR) imaging with an amplitude of low-frequency fluctuations (ALFF) algorithm. MATERIALS AND METHODS This study received institutional review board approval, and all subjects gave informed consent. Forty-four patients with ESRD, 24 of whom were undergoing PD (PD group; eight women; mean age, 34 years ± 8) and 20 who were not undergoing PD or hemodialysis (nondialysis group; six women; mean age, 37 years ± 9) and 24 healthy control subjects (eight women; mean age, 32 years ± 9 years) were included. All subjects underwent neuropsychologic tests, and patients with ESRD underwent laboratory testing. ALFF values were compared among the three groups. The relationship between ALFF values and clinical markers was investigated by using multiple regression analysis. RESULTS Patients in both the PD and nondialysis groups showed lower ALFF values in default mode network regions than did healthy control subjects (P < .01, false discovery rate corrected). Patients in the PD group showed lower ALFF values than did those in the nondialysis group in the left superior parietal lobe (1.51 ± 0.21 vs 2.01 ± 0.40), left inferior parietal lobe (0.99 ± 0.16 vs 1.13 ± 0.22) and left precuneus (1.45 ± 0.39 vs 1.77 ± 0.41) (P < .01, corrected with simulation software). In patients in the PD group, neuropsychologic test scores correlated with ALFF values of the middle temporal gyrus and the parietal and occipital lobe, serum urea and creatinine levels negatively correlated with ALFF in some default mode network regions, and hemoglobin positively correlated with ALFF in the bilateral precuneus, precentral, and supplementary motor areas (P < .01 corrected). CONCLUSION Patients with ESRD who were undergoing PD showed more severe spontaneous brain activity abnormalities that correlate with cognitive impairments than did patients who were not undergoing dialysis. Elevated serum urea, creatinine, and lowered hemoglobin levels affect spontaneous brain activity in patients with ESRD.
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Affiliation(s)
- Song Luo
- From the Department of Medical Imaging (S.L., R.F.Q., X.K., X.L., Q.X., G.Z., L.J.Z., G.M.L.) and National Clinical Research Center of Kidney Disease (J.Q.W., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China (J.H.Z.)
| | - Rong Feng Qi
- From the Department of Medical Imaging (S.L., R.F.Q., X.K., X.L., Q.X., G.Z., L.J.Z., G.M.L.) and National Clinical Research Center of Kidney Disease (J.Q.W., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China (J.H.Z.)
| | - Ji Qiu Wen
- From the Department of Medical Imaging (S.L., R.F.Q., X.K., X.L., Q.X., G.Z., L.J.Z., G.M.L.) and National Clinical Research Center of Kidney Disease (J.Q.W., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China (J.H.Z.)
| | - Jian Hui Zhong
- From the Department of Medical Imaging (S.L., R.F.Q., X.K., X.L., Q.X., G.Z., L.J.Z., G.M.L.) and National Clinical Research Center of Kidney Disease (J.Q.W., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China (J.H.Z.)
| | - Xiang Kong
- From the Department of Medical Imaging (S.L., R.F.Q., X.K., X.L., Q.X., G.Z., L.J.Z., G.M.L.) and National Clinical Research Center of Kidney Disease (J.Q.W., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China (J.H.Z.)
| | - Xue Liang
- From the Department of Medical Imaging (S.L., R.F.Q., X.K., X.L., Q.X., G.Z., L.J.Z., G.M.L.) and National Clinical Research Center of Kidney Disease (J.Q.W., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China (J.H.Z.)
| | - Qiang Xu
- From the Department of Medical Imaging (S.L., R.F.Q., X.K., X.L., Q.X., G.Z., L.J.Z., G.M.L.) and National Clinical Research Center of Kidney Disease (J.Q.W., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China (J.H.Z.)
| | - Gang Zheng
- From the Department of Medical Imaging (S.L., R.F.Q., X.K., X.L., Q.X., G.Z., L.J.Z., G.M.L.) and National Clinical Research Center of Kidney Disease (J.Q.W., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China (J.H.Z.)
| | - Zhe Zhang
- From the Department of Medical Imaging (S.L., R.F.Q., X.K., X.L., Q.X., G.Z., L.J.Z., G.M.L.) and National Clinical Research Center of Kidney Disease (J.Q.W., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China (J.H.Z.)
| | - Long Jiang Zhang
- From the Department of Medical Imaging (S.L., R.F.Q., X.K., X.L., Q.X., G.Z., L.J.Z., G.M.L.) and National Clinical Research Center of Kidney Disease (J.Q.W., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China (J.H.Z.)
| | - Guang Ming Lu
- From the Department of Medical Imaging (S.L., R.F.Q., X.K., X.L., Q.X., G.Z., L.J.Z., G.M.L.) and National Clinical Research Center of Kidney Disease (J.Q.W., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; Department of Biomedical Engineering and State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China (J.H.Z.)
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Multimodality MRI Findings in Patients with End-Stage Renal Disease. BIOMED RESEARCH INTERNATIONAL 2015; 2015:697402. [PMID: 26064943 PMCID: PMC4434172 DOI: 10.1155/2015/697402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/15/2015] [Indexed: 01/17/2023]
Abstract
Patients with end-stage renal disease (ESRD) suffer from a number of complex neurological complications including vascular damage and cognitive dysfunction. It is of great significance to detect the neurological complications and improve the prognosis of ESRD patients. Many new noninvasive MRI techniques have been steadily used for the diagnosis of occult central nervous system complications in ESRD patients. This gives an opportunity to understand the pathophysiological mechanisms of these neurological disorders. This paper is a review that presents the MRI findings of occult brain damage in ESRD patients, outlines the applications of advanced MRI techniques, and introduces a brief perspective in this study field.
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