{"title":"Microstructural and functional connectivity changes of decision-related brain networks in end-stage kidney disease patients undergoing peritoneal dialysis.","authors":"Jingjing Yin, Dongxue Luo, Shuhua Ma, Chudan Cai, Xiaoyan Shi, Yanqiang Peng, Jianwei Peng, Lingyu Chen, Yanmin Zheng, Ruiwei Guo, Zelin Zhuang, Zhirong Lin, Lei Xie","doi":"10.23876/j.krcp.24.146","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>We aimed to explore changes in decision-related brain microstructure, brain functional activities, and functional connectivity, and their correlations with cognitive function in end-stage kidney disease (ESKD) patients undergoing peritoneal dialysis (PD). Furthermore, the impact of dialysis on these changes was examined.</p><p><strong>Methods: </strong>Thirty ESKD patients undergoing PD, 20 chronic kidney disease (CKD) stage 5 patients without dialysis (predialysis CKD stage 5), and 30 healthy controls (HC) were recruited for the study. Various assessments have been conducted, including neuropsychological scale testing, decision-related behavioral tests, voxel-based morphometry, and functional magnetic resonance imaging.</p><p><strong>Results: </strong>Compared to the HC group, PD patients showed decreased functional activation and gray matter volume in multiple decision-related brain areas, including the ventromedial prefrontal cortex (vmPFC), orbitofrontal cortex (OFC), and anterior cingulate cortex (ACC) (p < 0.05, false discovery rate-corrected). The default mode network (DMN) and salience network (SAN) were the primary brain regions that showed decreased functional connectivity to the vmPFC and ACC. Additionally, compared to the predialysis group, the PD group showed enhanced brain activation in decision-related brain regions such as the ACC, vmPFC, and insula. Though PD and predialysis CKD stage 5 patients performed poorly in the neuropsychological and Iowa Gambling Task (IGT), there was no significant difference between the two groups. The structure and function variabilities of the vmPFC were correlated with IGT and Montreal Cognitive Assessment score, and the activation of OFC was negatively associated with blood creatinine, cystatin, and parathyroid hormone levels.</p><p><strong>Conclusion: </strong>In summary, PD can change the structure and function of decision-related brain circuits (vmPFC-OFC-ACC) and reduce integration within DMN and SAN, which is correlated with cognitive function and clinical features. Moreover, our findings may suggest the comparable capability of PD in preserving one's cognitive function and disease progression. Multimodal neuroimaging based on structure and function can provide more objective information for the early diagnosis and intervention of cognitive impairment in ESKD patients.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kidney Research and Clinical Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.23876/j.krcp.24.146","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: We aimed to explore changes in decision-related brain microstructure, brain functional activities, and functional connectivity, and their correlations with cognitive function in end-stage kidney disease (ESKD) patients undergoing peritoneal dialysis (PD). Furthermore, the impact of dialysis on these changes was examined.
Methods: Thirty ESKD patients undergoing PD, 20 chronic kidney disease (CKD) stage 5 patients without dialysis (predialysis CKD stage 5), and 30 healthy controls (HC) were recruited for the study. Various assessments have been conducted, including neuropsychological scale testing, decision-related behavioral tests, voxel-based morphometry, and functional magnetic resonance imaging.
Results: Compared to the HC group, PD patients showed decreased functional activation and gray matter volume in multiple decision-related brain areas, including the ventromedial prefrontal cortex (vmPFC), orbitofrontal cortex (OFC), and anterior cingulate cortex (ACC) (p < 0.05, false discovery rate-corrected). The default mode network (DMN) and salience network (SAN) were the primary brain regions that showed decreased functional connectivity to the vmPFC and ACC. Additionally, compared to the predialysis group, the PD group showed enhanced brain activation in decision-related brain regions such as the ACC, vmPFC, and insula. Though PD and predialysis CKD stage 5 patients performed poorly in the neuropsychological and Iowa Gambling Task (IGT), there was no significant difference between the two groups. The structure and function variabilities of the vmPFC were correlated with IGT and Montreal Cognitive Assessment score, and the activation of OFC was negatively associated with blood creatinine, cystatin, and parathyroid hormone levels.
Conclusion: In summary, PD can change the structure and function of decision-related brain circuits (vmPFC-OFC-ACC) and reduce integration within DMN and SAN, which is correlated with cognitive function and clinical features. Moreover, our findings may suggest the comparable capability of PD in preserving one's cognitive function and disease progression. Multimodal neuroimaging based on structure and function can provide more objective information for the early diagnosis and intervention of cognitive impairment in ESKD patients.
期刊介绍：
Kidney Research and Clinical Practice (formerly The Korean Journal of Nephrology; ISSN 1975-9460, launched in 1982), the official journal of the Korean Society of Nephrology, is an international, peer-reviewed journal published in English. Its ISO abbreviation is Kidney Res Clin Pract. To provide an efficient venue for dissemination of knowledge and discussion of topics related to basic renal science and clinical practice, the journal offers open access (free submission and free access) and considers articles on all aspects of clinical nephrology and hypertension as well as related molecular genetics, anatomy, pathology, physiology, pharmacology, and immunology. In particular, the journal focuses on translational renal research that helps bridging laboratory discovery with the diagnosis and treatment of human kidney disease. Topics covered include basic science with possible clinical applicability and papers on the pathophysiological basis of disease processes of the kidney. Original researches from areas of intervention nephrology or dialysis access are also welcomed. Major article types considered for publication include original research and reviews on current topics of interest. Accepted manuscripts are granted free online open-access immediately after publication, which permits its users to read, download, copy, distribute, print, search, or link to the full texts of its articles to facilitate access to a broad readership. Circulation number of print copies is 1,600.
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