Early detection of cognitive impairment in end-stage renal disease patients undergoing hemodialysis: insights from Resting-State functional connectivity analysis.

Abstract

Background: This study aims to investigate the characteristics of functional connectivity (FC) in neurologically asymptomatic patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) and experiencing cognitive impairment (CI).

Methods: 36 early-stage ESRD patients undergoing HD (ESHD) and 31 healthy control subjects underwent MRI scans. Abnormal FCs and networks were identified between the two groups, and correlation analysis and Area Under the Curve (AUC) analysis were conducted between abnormal FC regions and clinical variables.

Results: The ESHD group exhibited abnormal FCs in the posterior default mode network (DMN), attention network, and external visual network (VN). Significant correlations were observed between FC values of multiple brain regions and neurocognitive scores in the ESHD group. Additionally, the FC value of the right median cingulate gyrus negatively correlated with serum calcium levels. AUC analysis demonstrated that altered FC values in the left angular gyrus and the right supramarginal gyrus effectively distinguished patients with or without CI.

Conclusions: In conclusion, our study reveals multiple abnormal FC regions in asymptomatic ESHD patients, affecting visual-spatial processing, short-term memory, language, attention, and executive function. Altered FCs and their negative correlation with serum calcium levels highlight a potential link between metabolic disturbances and cognitive decline, suggesting new opportunities for targeted interventions in this vulnerable population.