Abnormalities Of Brain Structural And Functional Network In End Stage Renal Disease Based On Neuroimaging

End-stage renal disease(ESRD)is known as the glomerular filtration rate of<15mL/min/1.73 m~2,or the stage at which continuous dialysis therapy is essential.Dialysis treatment could remove the partial metabolites and excessive toxins to retain effective basic life support.Neuropsychologic study discovered a reversible part of low neuropsychologic testing in patients with ESRD who are receiving a single dialysis session,particularly in the abilities of memory,execution and psychomotor speed.On the other hand,regular dialysis treatment may abduct arterial hypoxemia,ephemeral hypotension,and undulations in electrolytes and brain water content,which maybe eventually result in the aberrant central nervous system.However,the relationship between the potential pathophysiological mechanisms of ESRD,dialysis treatment and the brain central nervous system were still largely unclear.Recently,neuroimaging had been widely used in the research of ESRD-related neurologic disorders,which could provide a novel perspective for understanding the neuropathological mechanism of ESRD patients.This study constructed brain functional and structural network through the resting state functional magnetic resonance imaging and diffusion tensor imaging data in patients with ESRD and healthy control,respectively.The relationship between brain network parameters and clinical indicators could be explored by using complex network theory,which would help us to powerfully understand the underlying physiological mechanisms of chronic renal failure and dialysis treatment.The main results are as follows:1.We constructed the whole-brain functional network by applying the resting state functional magnetic resonance imaging in ESRD patients during dialysis and healthy control(HC),and assessed the relationship between altered functional connectivity and clinical indicators.Results exhibited that the global and local efficiency in ESRD patients by dialysis was significantly decreased compared with healthy subjects,and mainly located at the amygdala and inferior frontal gyrus(IFG).At the same time,the nodal efficiency of the amygdala was significantly correlated with the performance of cognitive control in ESRD patients on dialysis.In addition,the functional connection between the amygdala-and IFG-related circuits also showed a significantly decreased in dialysis patients with ESRD.2.Based on the results of the resting-state functional brain network,we employed fiber tracing technology to construct brain white-matter structural network in HC,undergoing maintenance hemodialysis(MHD-ESRD)and end-stage renal disease patients before dialysis initiation(BDI-ESRD),and explored the impact of ESRD and dialysis treatment on brain structural connectivity organization.Results found the topological properties of the brain structural network showed significant differences among the three groups,including small-world characteristics,normalized clustering coefficient,normalized shortest path length and rich club parameters.Additionally,we only found that the relationship between the average fiber length of the rich club,feeder,and local connections and the clinical blood indicators in BDI-ESRD patients.In summary,ESRD may have a detrimental effect on the topological organization of the brain connectivity network,and dialysis treatment may be associated with aberrant microstructure integrity of the whole brain in patient with ESRD,which to some extent,providing radiological evidence for the in-depth understanding the pathological mechanism of chronic renal failure and dialysis therapy.