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Longitudinal relationship between chronic kidney disease and distribution of cerebral microbleeds in patients with
Qing Peng1, Wei Sun1, Wenhong Liu2
1Department of Neurology, Peking University First Hospital, Beijing, China.
Insights
Chronic kidney disease (CKD) is linked to deep or infratentorial cerebral microbleeds (CMB) in stroke patients. CKD progression further increases the risk of CMB evolution in these specific brain areas.
Area of Science:
- Neurology
- Nephrology
- Vascular Medicine
Background:
- Chronic kidney disease (CKD) is independently associated with cerebral microbleeds (CMB).
- Both CKD and CMB involve strain vessels, suggesting shared pathophysiological mechanisms.
- Understanding this relationship is crucial for managing stroke patients with kidney dysfunction.
Purpose of the Study:
- To investigate the association between CKD, CKD progression, and the distribution/evolution of CMB in ischemic stroke patients.
- To determine if CKD influences the development and worsening of CMB.
- To clarify the specific patterns of CMB affected by CKD.
Main Methods:
- Retrospective analysis of 500 ischemic stroke patients from the CASISP study.
- Assessment of CMB using the Microbleed Anatomical Rating Scale.
- Evaluation of renal function via estimated glomerular filtration rate (eGFR) and proteinuria.
Main Results:
- Decreased eGFR, proteinuria, CKD progression, and hypertension were independently associated with deep/infratentorial CMB at follow-up.
- CMB progression in deep/infratentorial areas was more frequent in patients with CKD progression.
- CKD progression was independently associated with the progression of deep/infratentorial CMB.
Conclusions:
- CKD and its progression are independently linked to the presence and evolution of deep or infratentorial CMB.
- This association was not observed for lobar CMB.
- Findings highlight the importance of renal function assessment in stroke patients with CMB.
Background:
Chronic kidney disease (CKD) has been reported to be independently associated with cerebral microbleeds (CMB). Since both glomerular afferent arterioles and cerebral perforating arteries are strain vessels, CKD and CMB may share similar dynamic changes.
Objective:
To clarify whether CKD and CKD progression are related to the distribution and evolution of CMB in patients with ischemic stroke.
Methods:
We retrospectively examined the data from the CASISP study. 500 patients with ischemic stroke were analyzed. The number and distribution of CMB were assessed using Microbleed Anatomical Rating Scale. Renal function was evaluated by the estimated glomerular filtration rate (eGFR) and proteinuria.
Results:
51 (10.2%) and 158 (31.6%) had decreased eGFR (<60ml/min/1.73m(2)) and CMB at baseline, respectively; 31 (6.6%) and 84 (16.8%) had CKD and CMB progression. Decreased eGFR at baseline (OR=1.533, 95% CI: 1.111-2.114; p=0.009), proteinuria (OR=1.778, 95% CI: 1.026-3.083; p=0.040), CKD progression (OR=2.004, 95% CI: 1.191-3.370; p=0.009) and history of hypertension (OR=2.084, 95% CI: 1.241-3.49; p=0.005) were independently associated with the presence of deep or infratentorial CMB at follow-up. CMB progression in deep or infratentorial area was more frequent in patients with CKD progression than those without (29.0% versus 13.1%, p=0.028). Logistic regression analyses showed that CKD progression (OR=2.577, 95% CI: 1.393-4.769; p=0.003) was independently associated with the progression of deep or infratentorial CMB.
Conclusion:
CKD and CKD progression are independently associated with presence and evolution of deep or infratentorial CMB, but not lobar CMB.
