Deteriorated functional and structural brain networks and normally appearing functional–structural coupling in diabetic kidney disease: a graph theory-based magnetic resonance imaging study
This study was conducted in order to investigate the topological organization of functional and structural brain networks in diabetic kidney disease (DKD) and its potential clinical relevance.
Two hundred two subjects (62 DKD patients, 60 diabetes mellitus [DM] patients, and 80 healthy controls) underwent laboratory examination, neuropsychological test, and magnetic resonance imaging (MRI). Large-scale functional and structural brain networks were constructed and graph theoretical network analyses were performed. The effect of renal function on brain functional and structural networks in DKD patients was further evaluated. Correlations were performed between network properties and neuropsychological scores and clinical variables.
Progressing deteriorated global and local network topology organizations (especially for functional network) were observed for DKD patients compared with control subjects (all p < 0.05, Bonferroni-corrected), with intermediate values for the patients with DM. DKD patients showed normally appearing functional–structural coupling compared with controls, while DM patients manifested functional–structural decoupling (p < 0.05, Bonferroni-corrected). Impaired kidney function markedly affected functional and structural network organization in DKD patients (all p < 0.05). Urea nitrogen correlated with global and local efficiency in the structural networks (r = − 0.551, p < 0.001; r = − 0.476, p < 0.001, respectively). Global and local efficiency in the structural networks and normalized characteristic path length in the functional networks were associated with information processing speed and/or psychomotor speed.
DKD patients showed enhanced functional and structural brain network disruption and normally appearing functional–structural coupling compared with DM patients, which correlated with kidney function, renal toxins, and cognitive performance.
• DKD patients showed markedly disrupted functional and structural brain network efficiency measures compared with DM patients and healthy controls.
• Reduced kidney function clearly deteriorated functional and structural brain networks in DKD patients.
• DKD patients displayed normally appearing functional–structural coupling compared with DM patients.
KeywordsDiabetic nephropathies Diabetes mellitus Diffusion tensor imaging Magnetic resonance imaging
Normalized clustering coefficient
Normalized characteristic path length
Automated anatomical labeling
American Diabetes Association
Analysis of covariance
Blood urea nitrogen
- Cyst C
Diabetic kidney disease
Data Processing Assistant for Resting-State fMRI
Diffusion tensor imaging
Estimated glomerular filtration rate
Fasting blood glucose
High-density lipoprotein cholesterol
Low-density lipoprotein cholesterol
Characteristic path length
Line Tracing Test
Mini-Mental State Examination
Montreal Cognitive Assessment
Magnetic resonance imaging
Number Connection Test type-A
Resting-state functional magnetic resonance imaging
Self-Rating Anxiety Scale
Self-Rating Depression Scale
Serial Dotting Test
Total intracranial volume
White matter lesions
This study was funded by grants from the National Natural Science Foundation of China (81322020, 81230032, 81471644).
Compliance with ethical standards
The scientific guarantor of this publication is Long Jiang Zhang.
Conflict of interest
The authors declare that they have no conflicts of interest.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have not been previously reported.
• performed at one institution
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