Chronic kidney disease correlates with MRI findings of cerebral small vessel disease

Cilia dysfunction in autosomal-dominant polycystic kidney disease (ADPKD) may impair the integrity of glymphatic system and be implicated in the progression of cerebral small vessel disease (SVD), although the link between the two diseases has not been investigated. We evaluated the association of ADPKD pathology with SVD pattern and severity. Overall, 304 individuals in an ADPKD (chronic kidney disease stage ≤4 and age ≥50 years) cohort and their age, sex, and estimated glomerular filtration rate (eGFR)-matched controls were retrospectively included. ADPKD severity was classified into 1 A-B, 1 C, and 1 D-E, according to age and height-adjusted total kidney volume. SVD parameters included white-matter hyperintensity (WMH) severity scale, enlarged perivascular space (ePVS) score, and degree of lacunes or cerebral microbleeds (CMBs). After adjustments for age, sex, eGFR, and cerebrovascular risk factor parameters, ADPKD was associated with higher ePVS scores ( P < 0.001), but not with the WMH severity or degree of lacunes or CMBs. In the ADPKD subgroup, higher ADPKD severity class was associated with higher ePVS scores ( P < 0.001), WMH severity ( P = 0.003), and degree of lacunes ( P = 0.002). ADPKD associated cilia dysfunction may induce chronic cerebral glymphatic system dysfunction, which may contribute to the specific progression of ePVS compared with other SVD markers.

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Abstract WP196: Chronic Kidney Disease and the Burden of Microvascular Brain Damage

Stroke ◽

10.1161/str.47.suppl_1.wp196 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Maria C Zurru ◽

Claudia Alonzo ◽

Laura Brescacín ◽

Pedro E Colla Machado ◽

Geraldina Linares ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Brain Damage ◽

Small Vessel Disease ◽

Vascular Risk Factor ◽

Small Vessel ◽

Low Grade ◽

Vessel Disease ◽

Dichotomous Variables ◽

Fazekas Scale

Introduction: chronic kidney disease (CKD) coexists with microvascular brain damage. This cerebrorenal connection is considered to involve small vessel disease in both the kidney and brain, based on their hemodynamic similarities. Hypothesis: to evaluate the relationship between microvascular brain damage (white matter hyperintensities -WMH-, microbleeds -MB- and silent brain infarcts -SBI-), and glomerular filtration rate (GFR) in a cohort of ischemic stroke patients. Methods: patients were prospectively included in a multidisciplinary secondary stroke prevention program. Pre-stroke vascular risk factor profile and control were obtained from electronic medical records and the burden of microvascular brain damage was evaluated on admission MRI. For the purpose of the analysis three groups were defined according to GFR estimated by Cockroft-Gault formula: >60, 30-60 and <30 ml/min/1.73 m2. Periventricular and deep WMH were classified according to Fazekas scale as low grade (0-1) and high grade (2-3); MB and SBI (lacunar and non-lacunar) were analyzed as dichotomous variables. Exclusion criteria: TIA and patients without MRI. Results: 808 patients (mean age 77±11 years, 59% females) were included. GRF was inversely related to age (70±11, 83±6, 85±8 years; p 0.0001), female sex (48%, 69%, 66%; p 0.001), hypertension (76%, 89%, 91%; p 0.0001) and AF (16%, 21%, 34%; p 0.08) prevalence. Chronic microvascular brain damage burden was inversely related to e-GFR (table). Conclusion: decreased GFR indicates small vessel disease not only in the kidney but also in the brain. As small vessel disease is a systemic disorder, information about disease in one organ may suggest damage in the other.

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