Changes in Cerebral Blood Flow Perfusion and Effective Connectivity in Brain Networks of Maintenance Hemodialysis Patients
Objective This study employs cerebral blood flow(CBF)measurements and Granger causality analysis(GCA)to investigate the alterations in CBF and the effects on whole-brain connectivity in patients with end-stage renal disease(ESRD)undergoing maintenance hemodialysis(MHD).Additionally,it aims to examine the correlation between these alterations and cognitive impairments in MHD patients.Methods This study included 29 MHD patients and an equal number of healthy controls,matched for age and gender,designated as the HC group.Functional magnetic resonance imaging was performed on all subjects,and the difference in blood flow perfusion between the two groups was used as a seed point for GCA analysis to observe the abnormal brain areas connected with the seed point shown in resting-state functional magnetic resonance imaging,and to correlate it with the clinical data and neuropsychological test results of MHD patients.Results Compared to the healthy control(HC)group,the MHD group showed significantly reduced cerebral blood flow(CBF)in the bilateral hippocampus and right insula(P＜0.05,FDR corrected).In the MHD group,the CBF in the right insula was negatively correlated with creatinine levels(P＜0.05).The MHD group also exhibited an increased connectivity effect from the right hippocampus to the right triangular inferior frontal gyrus.Additionally,connectivity from the left hippocampus to several regions,including the right calcarine fissure and surrounding cortex,right anterior cingulate and paracingulate gyrus,and right putamen and insula,was enhanced.Conversely,the connectivity from the left hippocampus to the left thalamus was reduced(P＜0.05,FDR corrected).Furthermore,the connectivity from the right hippocampus to the right triangular inferior frontal gyrus was found to be positively correlated with blood urea nitrogen(BUN)levels in the MHD group(P＜0.05).The connectivity from the left hippocampus to the right anterior cingulate and paracingulate gyrus correlated positively with naming scores.However,the connectivity to the right putamen was negatively associated with abstraction scores and dialysis duration,and the connectivity to the left thalamus was negatively correlated with naming scores(P＜0.05).Conclusion Patients with end-stage renal disease(ESRD)undergoing maintenance hemodialysis(MHD)exhibit alterations in cerebral blood flow and display abnormal connectivity patterns between the bilateral hippocampi and various brain regions,impacting cognitive function regulation.
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