Structural and functional brain alterations in end stage renal disease patients on routine hemodialysis: a voxel-based morphometry and resting state functional connectivity study.
OBJECTIVE
Cognitive impairment is a well-described phenomenon in end-stage renal disease (ESRD) patients. However, its pathogenesis remains poorly understood. The primary focus of this study was to examine structural and functional brain deficits in ESRD patients.


METHODS
Thirty ESRD patients on hemodialysis (without clinical neurological disease) and 30 age- and gender-matched control individuals (without renal or neurological problems) were recruited in a prospective, single-center study. High-resolution structural magnetic resonance imaging (MRI) and resting state functional MRI were performed on both groups to detect the subtle cerebral deficits in ESRD patients. Voxel-based morphometry was used to characterize gray matter deficits in ESRD patients. The impact of abnormal morphometry on the cerebral functional integrity was investigated by evaluating the alterations in resting state functional connectivity when brain regions with gray matter volume reduction were used as seed areas.


RESULTS
A significant decrease in gray matter volume was observed in ESRD patients in the bilateral medial orbito-prefrontal cortices, bilateral dorsal lateral prefrontal cortices, and the left middle temporal cortex. When brain regions with gray matter volume reduction were used as seed areas, the integration was found to be significantly decreased in ESRD patients in the fronto-cerebellum circuits and within prefrontal circuits. In addition, significantly enhanced functional connectivity was found between the prefrontal cortex and the left temporal cortex and within the prefrontal circuits.


CONCLUSIONS
Our study revealed that both the structural and functional cerebral cortices were impaired in ESRD patients on routine hemodialysis.
Department of Medical Imaging, Guangdong No. 2 Provincial People's Hospital, Guangzhou, PR China; Department of Medical Imaging, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China.
Yingwei
Y
Qiu
Departments of Medical Imaging and Interventional Radiology, Cancer Center, Sun Yat-Sen University, Guangzhou, PR China.
Xiaofei
X
Lv
Department of Medical Imaging, Guangdong No. 2 Provincial People's Hospital, Guangzhou, PR China.
Huanhuan
H
Su
Department of Medical Imaging, Guangdong No. 2 Provincial People's Hospital, Guangzhou, PR China.
Guihua
G
Jiang
Department of Renal Transplantation, Guangdong No. 2 Provincial People's Hospital, Guangzhou, PR China.
Cheng
C
Li
Department of Medical Imaging, Guangdong No. 2 Provincial People's Hospital, Guangzhou, PR China.
Junzhang
J
Tian
D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D016022:Case-Control Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D011446:Prospective Studies; D006435:Renal Dialysis