Association of Chronic Kidney Disease With Small Vessel Disease in Patients With Hypertensive Intracerebral Hemorrhage

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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Chronic kidney disease is associated with dementia independent of cerebral small-vessel disease

Neurology ◽

10.1212/wnl.0000000000000251 ◽

2014 ◽

Vol 82 (12) ◽

pp. 1051-1057 ◽

Cited By ~ 59

Author(s):

K. Miwa ◽

M. Tanaka ◽

S. Okazaki ◽

S. Furukado ◽

Y. Yagita ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Vessel Disease

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

Renal Failure ◽

10.1080/0886022x.2021.1873804 ◽

2021 ◽

Vol 43 (1) ◽

pp. 255-263

Author(s):

Tingting Yao ◽

Guoping Song ◽

Yuehua Li ◽

Dan Wang

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Mri Findings ◽

Vessel Disease

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Chronic kidney disease and cerebral small vessel disease: a casual or causal cerebrorenal relationship?

International Journal of Case Reports and Images ◽

10.5348/ijcri-201503-ed-10003 ◽

2015 ◽

Vol 6 (8) ◽

pp. 526

Author(s):

Marx Rivera-Zambrano ◽

Adrià Arboix ◽

María-José Sánchez

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Vessel Disease

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Chronic Kidney Disease as Risk Factor for Enlarged Perivascular Spaces in Patients With Stroke and Relation to Racial Group

Stroke ◽

10.1161/strokeaha.119.028688 ◽

2020 ◽

Vol 51 (11) ◽

pp. 3348-3351

Author(s):

Ashley A. Penton ◽

Helena Lau ◽

Viken L. Babikian ◽

Julie Shulman ◽

Anna Cervantes-Arslanian ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Basal Ganglia ◽

Kidney Disease ◽

Small Vessel Disease ◽

Racial Group ◽

Small Vessel ◽

Perivascular Spaces ◽

Racial Groups ◽

Centrum Semiovale ◽

Vessel Disease

Background and Purpose: Enlarged perivascular spaces (EPVS) are considered subclinical markers of small vessel disease, associated with increased risk of stroke and dementia. Increasing evidence links chronic kidney disease (CKD) to small vessel disease. We explored the relationship between CKD and EPVS burden and the influence of racial group in this relation. Methods: Consecutive patients with stroke who underwent brain magnetic resonance imaging were included (n=894). Racial group was categorized as White, Black, or other (other racial groups). CKD was defined by glomerular filtration rate <60 mL/minute per 1.73 m 2 for >3 months. EPVS were rated following a standardized method, dichotomized for analyses (mild [<20] versus severe [≥20]), and stratified by brain region (basal ganglia and centrum semiovale). Results: In multivariable-adjusted analysis, the association of CKD with severe EPVS varied across racial groups. Comparing patients with and without CKD within racial groups, we found that Whites with CKD had higher odds of severe centrum semiovale EPVS (odds ratio [OR], 2.41 [95% CI, 0.98–5.88]). Among patients with CKD, Black patients had higher odds of severe EPVS in the basal ganglia and centrum semiovale compared with Whites (OR, 1.93 [95% CI, 1.18–3.16] and OR, 1.90 [95% CI, 1.16–3.11], respectively) and other racial groups (OR, 2.03 [95% CI, 1.23–3.36] and OR, 2.02 [95% CI, 1.22–3.34], respectively). Conclusions: CKD was more prevalent in our sample of patients with stroke with severe EPVS in the centrum semiovale. The relation differed when stratified by racial group and brain topography. Further studies are needed to confirm that CKD may relate differently to subclinical measures of small vessel disease according to race.

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Abstract W P167: Lacunar Infarction and Hypertensive Intracerebral Hemorrhage-Similarities and Differences of Two Different Clinical Entities of Cerebral Small-Vessel Disease

Stroke ◽

10.1161/str.45.suppl_1.wp167 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Satoshi Suzuki ◽

Shigeru Fujimoto ◽

Takuya Inoue ◽

Ryosuke Tsuchimochi ◽

Takao Ishitsuka

Keyword(s):

Intracerebral Hemorrhage ◽

Aortic Arch ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Lacunar Infarction ◽

Small Vessel ◽

Vessel Disease ◽

Lowering Therapy ◽

History Of ◽

Hypertensive Intracerebral Hemorrhage

Introduction: Lacunar infarction (Lac) and hypertensive intracerebral hemorrhage (ICH) are known as cerebral small-vessel disease in which hypertension plays a pivotal role in the development of pathology. However, it is unclear why some patients suffer from cerebral infarction and others bleed. We compared the background of these two groups, and examined differences and similarities between them. Methods: Between February 2008 and January 2013, 1149 patients were admitted to our institution within 1 week after the onset of stroke. A database was prospectively constructed with this consecutive patients’ cohort and data were analyzed retrospectively. Among the patients, 138 had Lac and 109 had ICH. Results: Age, sex, and BMI were not different between the groups. Medication prior to the onset of stroke was more common in Lac than in ICH (77.5% vs. 55.1%; p<0.001). The frequency of antiplatelet therapy, blood pressure-lowering therapy, and lipid-lowering therapy was not different between the groups. Treatment for diabetes mellitus (DM) was significantly more frequent in Lac than in ICH (29.0% vs. 8.3%; p<0.001). Calcification of the aortic arch was significantly more common in Lac than in ICH (62.2% vs. 43.3%; p=0.009). Smoking, past history of stroke, and familial history of stroke were not different between the groups. Left-sided stroke was significantly more common in Lac than in ICH (63.8% vs. 50.4%; p=0.004). On admission, triglycerides, total cholesterol (Chol), HDL-Chol, LDL-Chol, total protein, serum albumin, and blood sugar levels were not different between the groups. HbA1c levels on admission were significantly higher in Lac than in ICH (6.4+/-1.3% vs. 5.9+/-1.0%; p=0.004). Conclusions: Lac and ICH have similar backgrounds. However, left-sided stroke, calcification of the aortic arch, and a medical history of DM are more common in Lac than in ICH patients. HbA1c values on admission are higher in Lac than in ICH patients. This suggests that there are subgroups of Lac in which the pathological process is different from that in ICH. Therefore, endothelial damage induced by DM may play a role in some patients with Lac, and left-sided propensity and a tendency for aortic arch calcification suggest that some aortogenic embolisms may be diagnosed as Lac.

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