Aberrant brain gray matter and functional networks topology in end stage renal disease patients undergoing maintenance hemodialysis with cognitive impairment

PURPOSE: To characterize the topological properties of gray matter (GM) and functional networks in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis to provide insights into the underlying mechanisms of cognitive impairment. MATERIALS AND METHODS: In total, 45 patients and 37 healthy controls were prospectively enrolled in this study. All subjects completed resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion kurtosis imaging (DKI) examinations and a Montreal cognitive assessment scale (MoCA) test. Differences in the properties of GM and functional networks were analyzed, and the relationship between brain properties and MoCA scores was assessed. Cognitive function was predicted based on functional networks by applying the least squares support vector regression machine (LSSVRM) and the whale optimization algorithm (WOA). RESULTS: We observed disrupted topological organizations of both functional and GM networks in ESRD patients, as indicated by significantly decreased global measures. Specifically, ESRD patients had impaired nodal efficiency and degree centrality, predominantly within the default mode network, limbic system, frontal lobe, temporal lobe, and occipital lobe. Interestingly, the involved regions were distributed laterally. Furthermore, the MoCA scores significantly correlated with decreased standardized clustering coefficient (γ), standardized characteristic path length (λ), and nodal efficiency of the right insula and the right superior temporal gyrus. Finally, optimized LSSVRM could predict the cognitive scores of ESRD patients with great accuracy. CONCLUSION: Disruption of brain networks may account for the progression of cognitive dysfunction in ESRD patients. Implementation of prediction models based on neuroimaging metrics may provide more objective information to promote early diagnosis and intervention.