【Objective】 To investigate dynamic regional homogeneity (dReHo) abnormality in end-stage renal disease (ESRD) patients by using resting-state functional magnetic resonance imaging (rs-fMRI). 【Methods】 A total of 26 ESRD patients and 26 healthy controls (HC) matched in gender, education level and age were included. Rs-fMRI scanning was performed in all subjects. All the subjects were tested by using auditory verbal learning test Huashan version (AVLT-H) and Montreal Cognitive Assessment (MoCA) to assess cognitive function before collection of MRI data. T-test was used to observe the difference in dReHo at global level between the two groups. Pearson and Spearman correlation analyses were made to estimate the correlation between abnormal brain regions and clinical scales. 【Results】 Compared with HC group, the dReHo value in ESRD patients reduced on the bilateral superior margin gyrus, left insula, left posterior central gyrus, and left putamen (P<0.05, replacement test correction). The dReHo values of left superior margin gyrus (r=-0.534, P=0.005) and left insula in ESRD patients (r=-0.422, P=0.032) were negatively correlated with the LR-S score, and the dReHo value of the left margin was negatively correlated with the SR-S score (r=-0.468, P=0.016). 【Conclusion】 There are abnormal dReHo values in several brain regions in ESRD patients during resting state, which is related to the patients’ cognitive function. The variation of dReHo value provides a new objective imaging basis for evaluating the cognitive function of ESRD patients.

【Objective】 To explore the correlation between abnormal thalamic functional connectivity (FC) and memory loss in maintenance hemodialysis patients with end-stage renal disease (ESRD). 【Methods】 An auditory verbal learning test (AVLT-H) was conducted on 22 patients with ESRD and 28 age-, sex-, and education-matched healthy controls (HC) to evaluate memory function. After that, resting-state functional magnetic resonance imaging (rs-fMRI) data were gathered, and a whole-brain FC analysis centered on the thalamus was executed to discern variations in thalamic FC between the two groups. Finally, Pearson and Spearman correlation analyses were carried out. 【Results】 Compared to the HC group, the ESRD group exhibited notably lower scores in IR-S (P=0.002), SR-S (P<0.001), and LR-S (P=0.005). Concurrently, the ESRD group demonstrated diminished FC of the right thalamus with the left superior frontal gyrus, the left parietal lobule, the right suproccipital gyrus, the right anterior cuneus, and the right middle frontal gyrus (P<0.05, TFCE correction). Additionally, reduced FC were observed between the left thalamus and the left gyrus rectus, the left parietal lobule, and the right parietal lobule in the ESRD group (P<0.05, TFCE correction). Moreover, the FC values between the left thalamus and the left gyrus rectus in the ESRD group displayed significant negative correlations with IR-S (r=-0.499), SR-S (r=-0.458), and LR-S (r=-0.455) (all P<0.05). 【Conclusion】 Memory impairment is evident in ESRD patients undergoing maintenance hemodialysis, and it appears to be intricately linked to anomalous FC within the left thalamus and the left gyrus rectus. These findings offer potential imaging markers for monitoring memory dysfunction in individuals with ESRD.

【Objective】 To explore the mediating role of depression between uremic toxins and cognitive function in end-stage renal disease (ESRD) patients, so as to provide a basis for early clinical intervention. 【Methods】 A retrospective study involved 49 predialysis ESRD patients diagnosed in the Nephrology Department of The First Affiliated Hospital of Xi’an Jiaotong University between August 2018 and October 2021, along with 50 healthy controls (HC). General information of the two groups was collected. Montreal Cognitive Assessment (MoCA), Auditory Verbal Learning Test-Huashan Version (AVLT-H), Trail Making Test A (TMT-A), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were used to collect data on cognitive function, anxiety, and depression in both groups. Serological indicators in the ESRD group were used to clarify the impact of uremic toxins on cognitive function. PROCESS v3.4.1 was applied to explore the relationship between uremic toxins, depression, and cognitive function, as well as the mediating effect of depression. 【Results】 Significant differences were found between the ESRD group and the HC group in MoCA total score (P<0.001), AVLT-H (word learning; short-term delay; long-term delay,P<0.001; word recognition, P=0.001), TMT-A (P<0.001), BDI (P<0.001), and BAI (P=0.009). Cystatin C was a negative influencing factor for short-term delay in AVLT-H (B=-0.834, P=0.019), while BDI was a negative influencing factor for long-term delay in AVLT-H (B=-0.102, P=0.002), word recognition in AVLT-H (B=-0.071, P<0.001), and MoCA total score (B=-0.135, P=0.002). BDI partially mediated the effect of cystatin C on short-term delay in AVLT-H (total effect, c=-0.3346; direct effect, c′=-0.223 5; mediating effect, a×b=-0.111 0; and mediating effect proportion, 33.2%) and long-term delay in AVLT-H (total effect, c=-0.318 7; direct effect, c′=-0.218 8; mediating effect, a×b=-0.099 9; and mediating effect proportion, 31.3%). 【Conclusion】 ESRD patients experience cognitive decline as well as anxiety and depression. Cystatin C and depression are both negative influencing factors for cognitive decline in ESRD patients. Cystatin C indirectly affects cognitive function in ESRD patients through depression.