Longitudinally altered default mode network and insula multimodal brain pattern in end-stage renal disease during sustained hemodialysis treatment.

A specific pattern of altered connectivity between the default mode network and the insula, detected via unsupervised fusion of functional and structural MRI, was found in 39 people with end-stage renal disease receiving hemodialysis over one year. This pattern was linked to cognitive performance, and its associated genes were enriched in DNA damage repair, energy metabolism, and cellular activation. The baseline pattern predicted future cognition in this group, and similar brain-cognition associations were validated in independent cohorts with major depressive disorder (n=60), mild cognitive impairment (n=291), and Alzheimer's disease (n=77).

Study at a glance

Abstract

Hemodialysis (HD) is the predominant treatment for end-stage renal disease (ESRD). Despite the efficacy of HD, the neurobiological underpinnings underlying high-risk complications remain unclear. In this study, using unsupervised fusion of functional and structural MRI, we identified a longitudinally altered default mode network (DMN)-insula pattern in ESRD receiving HD over 1-year follow-up (n = 39). This pattern was associated with cognition, and its related genes were enriched in biological processes involving DNA damage and repair, energy metabolism, and cellular activation. The baseline DMN-insula pattern demonstrated potential predictive value for follow-up cognition in ESRD. More importantly, these brain-cognition associations were validated in independent high-risk complications cohorts, including major depressive disorder (n = 60), mild cognitive impairment (n = 291), and Alzheimer's disease (n = 77) by extracting the corresponding brain features and assessing their correlations with cognition. Collectively, this study may help researchers better understand the underlying mechanisms of ESRD receiving HD from a multimodal neuroimaging and molecular perspective.