Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China.
Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China.
BMC Nephrol. 2020 Nov 26;21(1):515. doi: 10.1186/s12882-020-02176-y.
End-stage renal disease (ESRD) patients are at a substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. Based on previous research, there isn't an uncontested result whether cognition was improved or worsened during dialysis.
To explore the impact of dialysis treatment on cognitive performance, we recruited healthy controls (HCs), predialysis ESRD patients (predialysis group), and maintenance hemodialysis ESRD patients (HD group). All ESRD patients performed six blood biochemistry tests (hemoglobin, urea, cystatin C, Na+, K+, and parathyroid hormone). Neuropsychological tests were used to measure cognitive function. By using diffusion tensor imaging and graph-theory approaches, the topological organization of the whole-brain structural network was investigated. Generalized linear models (GLMs) were performed to investigate blood biochemistry predictors of the neuropsychological tests and the results of graph analyses in the HD group and predialysis group.
Neuropsychological analysis showed the HD group exhibited better cognitive function than the predialysis group, but both were worse than HCs. Whole-brain graph analyses revealed that increased global efficiency and normalized shortest path length remained in the predialysis group and HD group than the HCs. Besides, a lower normalized clustering coefficient was found in the predialysis group relative to the HCs and HD group. For the GLM analysis, only the Cystatin C level was significantly associated with the average fiber length of rich club connections in the predialysis group.
Our study revealed that dialysis had a limited effect on cognitive improvement.
与健康人群相比，终末期肾病（ESRD）患者发生认知障碍的风险显著更高。透析是维持 ESRD 患者生命的一种重要方式。基于既往研究，对于透析过程中认知功能是改善还是恶化，尚无定论。
为了探究透析治疗对认知表现的影响，我们招募了健康对照者（HCs）、透析前 ESRD 患者（透析前组）和维持性血液透析 ESRD 患者（HD 组）。所有 ESRD 患者进行了 6 项血液生化检查（血红蛋白、尿素、胱抑素 C、Na+、K+和甲状旁腺激素）。采用神经心理学测试来测量认知功能。通过弥散张量成像和图论方法，研究了全脑结构网络的拓扑组织。在 HD 组和透析前组中，采用广义线性模型（GLMs）分析血液生化指标对神经心理学测试和图分析结果的预测作用。
神经心理学分析显示，HD 组的认知功能优于透析前组，但均逊于 HCs。全脑图分析显示，与 HCs 相比，透析前组和 HD 组的全局效率和标准化最短路径长度增加，而标准化聚类系数降低。此外，与 HCs 和 HD 组相比，透析前组的富连接聚类系数较低。对于 GLM 分析，仅在透析前组中，Cystatin C 水平与丰富连接的平均纤维长度显著相关。
本研究表明，透析对认知改善的效果有限。
