Altered functional connectivity and its association with cognitive impairment in pre-dialysis end-stage renal disease
ZHANG Pan
ZHANG Guirong
ZHANG Ming
DING Dun
Abstract：Objective To investigate alterations in brain function in patients with end-stage renal disease(ESRD)prior to their first dialysis using the fractional amplitude of low-frequency fluctuation(fALFF)and functional connectivity(FC)analyses of resting-state functional magnetic resonance imaging(rs-fMRI),and to further analyze the correlation between these brain functional changes and cognitive scores.Methods Forty-eight ESRD patients(ESRD group)scheduled for renal replacement therapy were recruited from our hospital from April 2023 to March 2025,along with 44 matched healthy volunteers(control group).All participants underwent rs-fMRI scanning and cognitive assessment using the Montreal Cognitive Assessment(MoCA).fALFF differences between the two groups were compared.Brain regions showing significant differences were used as regions of interest(ROIs)for subsequent FC analysis to investigate the functional integration patterns between these ROIs and whole-brain voxels.After controlling for the effects of age,gender,and education level,partial correlation analyses were conducted between the fALFF values/FC values of the identified brain regions and the MoCA scores.Results The MoCA scores were significantly lower in the ESRD group compared to the control group(P<0.001).Compared with controls,ESRD patients showed decreased fALFF values in PCUN.R(t=-5.445,Cluster-level FWE correction,P<0.05,with clusters comprising a minimum of 67 voxels).FC analysis revealed that ESRD patients had decreased FC between PCUN.R and SMG.R(P<0.001,uncorrected)as well as DCG.R(P<0.001,uncorrected),but increased FC between PCUN.R and MFG.R(P<0.001,uncorrected).After controlling for gender,age,and education level,the FC value between PCUN.R and SMG.R showed a significant positive correlation with the MoCA score of ESRD patients(r=0.346,P<0.05,FDR-corrected,k=4).Conclusion Patients with ESRD exhibit altered spontaneous brain activity and functional connectivity within the default mode network(DMN)at rest,which are closely associated with cognitive function.These findings provide novel neuroimaging evidence for understanding the neuropathophysiological mechanisms underlying cognitive impairment associated with ESRD prior to the initiation of dialysis.
Keywords：end-stage renal diseaseresting-state functional MRIfractional amplitude of low frequency fluctuationfunctional connectivitycognitive dysfunction
Publication Date：2026-02-20
Online Publishing Date：2026-03-25(First online date of this platform, not the publication date of the document)
Pages：6( 205-210 )