Resting-state BOLD-CBF coupling in end-stage renal disease with diabetic kidney disease patients: associations with clinical characteristics and cognitive function.
Objectives Patients with diabetic kidney disease (DKD) are at increased risk of cognitive impairment, but the underlying alterations in resting-state BOLD-CBF coupling remain unclear. This study aimed to investigate changes in resting-state BOLD-CBF coupling and their associations with clinical characteristics and cognitive function in DKD. Resting-state functional MRI (rs-fMRI) and arterial spin labeling (ASL) were performed in 36 patients with DKD, 36 patients without DKD, and 37 healthy controls. Amplitude of low-frequency fluctuations (ALFF) derived from rs-fMRI and cerebral blood flow (CBF) derived from ASL were used to calculate the ALFF-CBF coupling coefficient, which was used to characterize resting-state BOLD-CBF coupling. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) before MRI examination. Laboratory tests were also performed, and correlations with clinical variables and MoCA scores were analyzed. Compared with the non-DKD group, the DKD group showed significantly reduced resting-state BOLD-CBF coupling in several brain regions. In the DKD group, glycated hemoglobin A1c levels negatively correlated with resting-state BOLD-CBF coupling in the bilateral medial superior frontal gyrus, while hemoglobin levels positively correlated with resting-state BOLD-CBF coupling in multiple brain areas. And resting-state BOLD-CBF coupling in the left hippocampus was linked to MoCA score. DKD patients exhibited more pronounced alterations in resting-state BOLD-CBF coupling compared to non-DKD patients, potentially linked to elevated blood glucose levels.