Disturbed Dynamic Brain Activity and Neurovascular Coupling in End-Stage Renal Disease Assessed With MRI

Area of Science:

• Neuroscience
• Nephrology
• Radiology

Background:

• Cognitive impairment in end-stage renal disease (ESRD) has unclear pathophysiological mechanisms.
• Limited research exists on temporal variability of neural activity and its coupling with regional perfusion in ESRD.

Purpose of the Study:

• To assess neural activity and neurovascular coupling (NVC) in ESRD patients.
• To evaluate the classification performance of these abnormalities.
• To explore relationships between neural/NVC abnormalities and cognitive function.

Main Methods:

• Prospective study involving 33 ESRD patients and 35 healthy controls (HCs).
• Utilized 3.0T/3D pseudo-continuous arterial spin labeling, resting-state functional MRI, and 3D-T1 weighted structural imaging.
• Assessed dynamic (dfALFF) and static (sfALFF) fractional amplitude of low-frequency fluctuations, cerebral blood flow (CBF), CBF-fALFF correlations, CBF/fALFF ratios, and cerebral small vessel disease (CSVD) MRI features.

Main Results:

• ESRD patients showed higher dfALFF in the left IFGtriang and left MTG, and lower CBF/dfALFF and CBF/sfALFF ratios in several brain regions.
• The CBF/dfALFF ratio demonstrated superior classification performance (AUC=0.916) in distinguishing ESRD patients from HCs compared to other measures.
• In ESRD patients, decreased CBF/fALFF ratios correlated with renal impairment, increased CSVD burden, and cognitive decline.

Conclusions:

• ESRD patients exhibit abnormal dynamic brain activity and impaired NVC.
• Dynamic brain activity features show superior discriminative capacity for identifying ESRD.
• The CBF/dfALFF ratio is a powerful classification tool for distinguishing ESRD patients.