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Prognostic Relationships between Microbleed, Lacunar Infarction, White Matter Lesion, and Renal Dysfunction in Acute
Jae Woong Jeon1, Hye Seon Jeong2, Dae Eun Choi1
1Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
Background:
It is well known that renal dysfunction and cerebral small-vessel disease (SVD), including microbleed, lacunar infarction, and white matter lesion (WML), are associated with poor prognosis after ischemic stroke. However, the prognostic relationship between renal dysfunction and SVD has not been well evaluated in acute ischemic stroke survivors. Therefore, in this study, we evaluated the prognostic relationships between estimated glomerular filtration rate (eGFR) and cerebral SVD after acute ischemic stroke.
Methods:
We retrospectively reviewed the clinical and radiological data of acute ischemic stroke survivors with decreased eGFR (<60 mL/min/1.73 m2, n = 128) and controls (eGFR ≥60 mL/min/1.73 m2, n = 128). The presence of SVD was evaluated according to magnetic resonance imaging performed on admission. Mortality data were obtained from medical chart reviews and telephone interviews.
Results:
Patients with silent lacunar infarction, WML, or microbleed had lower eGFR than patients without such lesions (60.4 ± 34.8 versus 87.5 ± 28.4 mL/min/1.73 m2, 60.5 ± 37.1 versus 73.9 ± 33.3 mL/min/1.73 m2, and 57.6 ± 33.3 versus 73.9 ± 32.9 mL/min/1.73 m2, respectively). In addition, the multivariate adjusted odds ratio for the presence of SVD increased inversely with eGFR. Three-year survival was lower in patients with renal dysfunction and each type of SVD. The presence of WML was an independent risk factor for cardiovascular death.
Conclusions:
Renal impairment was associated with the presence of SVD in acute ischemic stroke survivors. Both renal impairment and the presence of SVD were predictors of poor poststroke survival.
Insights
Renal dysfunction and cerebral small-vessel disease (SVD) are linked to poor outcomes in stroke survivors. Both conditions independently predict worse survival after ischemic stroke, highlighting the need for integrated management.
Area of Science:
- Neurology
- Nephrology
- Cardiology
Background:
- Renal dysfunction and cerebral small-vessel disease (SVD) are known prognostic factors for ischemic stroke.
- The interplay between renal dysfunction and SVD in acute ischemic stroke survivors requires further investigation.
Purpose of the Study:
- To evaluate the prognostic relationship between estimated glomerular filtration rate (eGFR) and cerebral SVD in acute ischemic stroke survivors.
- To determine if renal dysfunction and SVD are independent predictors of post-stroke survival.
Main Methods:
- Retrospective review of clinical and radiological data from 256 acute ischemic stroke survivors.
- Categorization into groups based on eGFR: decreased (<60 mL/min/1.73 m²) and normal (≥60 mL/min/1.73 m²).
- Assessment of SVD presence (microbleed, lacunar infarction, white matter lesion) via MRI; mortality data collected over three years.
Main Results:
- Patients with SVD (lacunar infarction, WML, microbleed) exhibited significantly lower eGFR compared to those without SVD.
- An inverse relationship was observed between eGFR and the odds of SVD presence.
- Three-year survival rates were lower in patients with renal dysfunction and any type of SVD; WML independently predicted cardiovascular death.
Conclusions:
- Renal impairment is associated with the presence of SVD in acute ischemic stroke survivors.
- Both renal impairment and SVD are significant predictors of poor post-stroke survival.
- These findings underscore the importance of assessing both renal function and SVD for risk stratification in stroke patients.
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