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Changes of Brain Functional Connectivity in End-Stage Renal Disease Patients Receiving Peritoneal Dialysis Without Cognitive Decline.

ABSTRACT: Background: Functional connectivity detected by resting-state functional MRI (R-fMRI) helps to discover the subtle changes in brain activities. Patients with end-stage renal disease (ESRD) on hemodialysis (HD) have impaired brain networks. However, the functional changes of brain networks in patients with ESRD undergoing peritoneal dialysis (PD) have not been fully delineated, especially among those with preserved cognitive function. Therefore, it is worth knowing about the brain functional connectivity in patients with PD by using R-fMRI. Methods: This case-control study prospectively enrolled 19 patients with ESRD receiving PD and 24 age- and sex- matched controls. All participants without a history of cognitive decline received mini-mental status examination (MMSE) and brain 3-T R-fMRI. Comprehensive R-fMRI analyses included graph analysis for connectivity and seed-based correlation networks. Independent t-tests were used for comparing the graph parameters and connectivity networks between patients with PD and controls. Results: All subjects were cognitively intact (MMSE > 24). Whole-brain connectivity by graph analysis revealed significant differences between the two groups with decreased global efficiency (Eglob, p < 0.05), increased betweenness centrality (BC) (p < 0.01), and increased characteristic path length (L, p < 0.01) in patients with PD. The functional connections of the default-mode network (DMN), sensorimotor network (SMN), salience network (SN), and hippocampal network (HN) were impaired in patients with PD. Meanwhile, in DMN and SN, elevated connectivity was observed in certain brain regions of patients with PD. Conclusion: Patients with ESRD receiving PD had specific disruptions in functional connectivity. In graph analysis, Eglob, BC, and L showed significant connectivity changes compared to the controls. DMN and SN had the most prominent alterations among the observed networks, with both decreased and increased connectivity regions. Our study confirmed that significant changes in cerebral connections existed in cognitively intact patients with PD.

SUBMITTER: Chang TY

PROVIDER: S-EPMC8652044 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Urgent-start peritoneal dialysis (PD) can help patients with end-stage renal diseases (ESRD) that are referred late to dialysis. However, catheter patency and related complications of urgent-start PD have not been thoroughly clarified. We investigated the clinical outcomes of urgent-start PD in a Chinese cohort. METHODS:We enrolled ESRD patients who received urgent-start PD (starting PD within 14?days after catheter insertion) in our center from January 1, 2006 to December 31, 2014, and followed them up for 10?years. The primary outcome was catheter failure. Secondary outcomes included short-term and long-term complications related to urgent-start PD. RESULTS:Totally 2059 patients (58.9% male, mean age 47.6?±?15.9?years) were enrolled. Few perioperative complications were observed, including significant hemorrhage (n?=?3, 0.1%) and bowel perforation (n?=?0). Early peritonitis occurred in 24 (1.2%) patients (0.28 episodes per patient-year). Within the first month after catheter insertion, functional catheter malfunction occurred in 85 (4.1%) patients, and abdominal wall complications (including hernia, hydrothorax, hydrocele, and leakage) in 36 (1.7%) patients. During a median 36.5 (17.7-61.4) months of follow-up, 75 (3.6%) patients experienced catheter failure, and 291 (14.1%) had death-censoring technique failure. At the end of 1-month, 1 -year, 3-year, and 5-year, catheter patency rate was 97.6, 96.4, 96.2, 96.2%; and technique survival rate was 99.5, 97.0, 90.3, 82.7%, respectively. After adjusting for confounders, every 5-year increase in age was associated with 19% decrease of risk for catheter failure (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.73-0.89). Male sex (HR: 1.43, 95% CI: 1.00-2.04), diabetic nephropathy (HR: 1.56, 95% CI: 1.08-2.25) and low hemoglobin levels (HR: 0.89, 95% CI: 0.81-0.98) were independent risk factors for abdominal wall complications. CONCLUSIONS:Urgent-start PD is a safe and efficacious option for unplanned ESRD patients. A well-trained PD team, a standardized catheter insertion procedure by experienced nephrologists, and a carefully designed initial PD prescription as well as comprehensive follow-up care, might be essential for the successful urgent-start PD program.

Project description:BackgroundPeritoneal dialysis (PD) is an easily implementable dialysis modality in end-stage renal disease (ESRD). PD may improve access to renal replacement therapy in low- and middle-income countries; however, these countries have a higher prevalence of protein-energy wasting in patients and poorer socioeconomic conditions. We evaluated the effects of HIV infection on serum albumin levels in ESRD patients starting continuous ambulatory PD (CAPD) and mortality outcomes.MethodsWe conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa, from September 2012 to February 2015. Seventy HIV-negative and 70 HIV-positive ESRD patients were followed monthly for serum albumin levels and mortality events during the first 18 months of CAPD therapy.ResultsThe HIV-positive cohort recorded 28 deaths (40%) among patients with a functional CAPD catheter at 18 months and 13 deaths (18.6%) in the HIV-negative cohort (p = 0.005). The mean serum albumin levels were lower in the HIV-positive cohort than in the HIV-negative cohort during the 18-month follow-up. The mean difference in serum albumin levels between the two cohorts was 4.24 g/L (95% confidence interval [CI] 2.02-6.46, p<0.001) at baseline and 3.99 g/L (95% CI 1.19-6.79, p = 0.006) at 18 months. HIV-positive status (adjusted regression coefficient -2.84, CI -5.00--0.67, p = 0.011), diabetes (adjusted coefficient -2.85; CI, -5.58--0.12; p = 0.041), and serum C-reactive protein and blood hemoglobin levels were independent predictors of serum albumin levels on multivariable linear regression. Baseline serum albumin <25 g/L (subdistribution-hazard ratio [SHR] 13.06, 95% CI 3.09-55.14, p<0.001) and CD4+ cell count <200 cells/?L (SHR 3.2, CI 1.38-7.45, p = 0.007) were independent predictors of mortality in our competing risk model.ConclusionsHIV infection can adversely affect serum albumin levels in ESRD patients managed with CAPD, while low baseline serum albumin levels and impaired immunity reliably predict mortality.

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Changes of Brain Functional Connectivity in End-Stage Renal Disease Patients Receiving Peritoneal Dialysis Without Cognitive Decline.

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