Cognitive Impairment in Chronic Kidney Disease Across Different Stages: The Role of Structural and Perfusion‐Driven Functional Connectivity Changes

ABSTRACT

Introduction

Chronic kidney disease (CKD) is associated with cognitive impairment (CI), yet the exact pathophysiological mechanisms remain unclear. This study aims to investigate the alterations in gray matter volume (GMV) and cerebral blood flow (CBF) across CKD stages, identify co‐changed brain regions, explore abnormal seed‐based functional connectivity (FC) in patients with CKD, and investigate the correlation between the abnormal brain regions and neuropsychological test scores.

Methods

Two hundred and eight participants (66 healthy controls, 70 CKD Stages 1–3a, and 72 CKD Stages 3b–5) were consecutively recruited and underwent high‐resolution T1‐weighted imaging, arterial spin labeling, and functional MR imaging. The imaging parameters were compared among three groups, and correlations with MoCA scores were analyzed.

Results

Compared to CKD 1–3a group, the bilateral fusiform gyrus (FFG.L and FFG.R) exhibited reduced GMV, increased CBF, and decreased FFG.L‐FC with bilateral inferior frontal gyrus, triangular part (IFGtriang.L and IFGtriang.R), left middle occipital gyrus (MOG.L), and left hippocampus (HIP.L), as well as decreased FFG.R‐FC with bilateral median cingulate and paracingulate gyri (DCG.L and DCG.R), left superior frontal gyrus, medial (SFGmed.L), IFGtriang.L, and right middle temporal gyrus (MTG.R) in CKD 3b–5 group. A negative correlation was observed between the MoCA scores and FFG.L‐FC with right middle frontal gyrus (MFG.R), IFGtriang.L, IFGtriang.R, HIP.L, and left putamen in patients with CKD 1–3a.

Conclusion

Brain structural and perfusion alterations may underlie the reduced FC between fusiform gyrus and cognitive‐related regions, providing potential neuroimaging evidence for the neuropathological mechanisms of CI in patients with different stages CKD.

Abstract

Patients with CKD, particularly in early stages, may exhibit changes in GMV and CBF, which can lead to decreased FC between the fusiform gyrus and cognitive‐related regions in advanced‐stage CKD. CKD, chronic kidney disease; CKD3b‐5, patients with stage 3b‐5 chronic kidney disease; CKD1‐3a, patients with stage 1‐3a chronic kidney disease; HC, healthy control; MNI, montreal neurological institute; FC, functional connectivity; GRF, Gaussian random field. FFG.L, left fusiform gyrus; FFG.R, right fusiform gyrus.