Structural network topology correlates to cognitive impairment and iPTH level in End-stage renal disease patients with peritoneal dialysis
Abstract Objective: The burden of cognitive impairment in patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis has received more attention lately. It is associated with hospitalization, mortality and poorer quality of life. We aimed to assess the topological alterations of the brain white matter structural network in ESRD and the correlation between network metrics with Montreal Cognitive Assessment scores and clinical data. Methods: The study included 25 ESRD patients with secondary hyperparathyroidism (SHPT group), 25 patients without SHPT (Non-SHPT group) and 25 healthy controls (HC group) of comparable age and sex. Montreal Cognitive Assessment was used to assess the cognitive function. The WM structural network was constructed by DTI technique, and then we used graph theoretical approaches to detect changes in the global and regional properties of the WM networks in these participants through deterministic tractography method. Results: ESRD patients showed cognitive impairment compared to HC, and the SHPT patients had lower cognitive scores than the Non-SHPT patients. The global topological organization and local efficiency of the WM network was significantly disrupted in the SHPT but not in the Non-SHPT patients compared with the HC group. Moreover, lower regional efficiency was found in the ESRD patients, mainly distributed in the frontal and parietal cortices. In addition, an association was found between iPTH, shortest path length and cognitive impairment, and the iPTH level was negatively correlated with small-worldness by two indexes, the normalized clustering coefficient and the normalized shortest path length. Conclusion: The present study indicated that the brain structural connectome in ESRD patients with high iPTH levels was disrupted in association with cognitive impairment and it is a potential connectome-based biomarker for early detection.