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Cerebral Microbleeds and Chronic Kidney Disease in Acute Ischemic Stroke Patients with Atrial Fibrillation
Kazuo Yamashiro1, Ryota Tanaka2, Naohide Kurita3
1Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
Insights
Chronic kidney disease (CKD) is linked to cerebral microbleeds (CMBs) in patients with atrial fibrillation (AF) and stroke. Maintaining kidney function may help prevent CMBs in this population.
Area of Science:
- Neurology
- Nephrology
- Cardiology
Background:
- Cerebral microbleeds (CMBs) increase intracerebral hemorrhage risk in atrial fibrillation (AF) stroke patients.
- The relationship between CMBs and chronic kidney disease (CKD) in acute ischemic stroke with AF is not well-established.
Purpose of the Study:
- To investigate the association between CMBs and CKD in patients experiencing acute ischemic stroke with AF.
Main Methods:
- Retrospective analysis of acute ischemic stroke patients with AF undergoing MRI.
- Assessment of CMBs (number and distribution) and kidney function (eGFR).
Main Results:
- CKD was present in 36.7% of patients; 29.4% had CMBs.
- CKD patients had a significantly higher prevalence of CMBs, particularly deep/infratentorial and mixed types.
- CKD independently associated with any CMB (OR 1.89) and mixed CMBs (OR 3.10); moderate-to-severe CKD associated with multiple CMBs (OR 2.31).
Conclusions:
- CMBs and CKD are common in acute ischemic stroke patients with AF.
- CKD may be an independent risk factor for CMBs in this cohort.
- Longitudinal studies are needed to confirm if preserving kidney function prevents CMB development.
Background:
Cerebral microbleeds (CMBs) are associated with the risk of intracerebral hemorrhage in stroke patients with atrial fibrillation (AF). We investigated the association between CMBs and chronic kidney disease (CKD) in patients with acute ischemic stroke and AF.
Methods:
We retrospectively examined consecutive patients with acute ischemic stroke and AF who underwent brain gradient-echo T2*-weighted magnetic resonance imaging. The number and distribution (lobar, deep or infratentorial, and mixed) of CMBs were assessed. Kidney function was assessed according to the estimated glomerular filtration rate (eGFR), which was calculated using a modified version of the Modification of Diet in Renal Disease equation.
Results:
Of the 357 included patients, 105 (29.4%) had CMBs. CKD (eGFR < 60 mL/min/1.73 m2) was found in 131 (36.7%) patients. Patients with CKD showed a higher prevalence of any form of CMB (41.2% versus 22.6%, P < .001), deep or infratentorial CMBs (19.9% versus 9.3%, P < .01), and mixed CMBs (14.5% versus 5.3%, P < .01) than those without CKD. After adjusting for age and other confounding factors, CKD was found to be independently associated with the presence of any form of CMB (odds ratio 1.89, P = .02) and mixed CMBs (odds ratio 3.10, P < .01). Moreover, moderate to severe CKD (eGFR < 45 mL/min/1.73 m2) was independently associated with the presence of multiple CMBs (odds ratio 2.31, P = .04).
Conclusions:
CMBs and CKD are common in acute ischemic stroke patients with AF, and CKD may be a risk factor for CMBs. Further longitudinal studies are needed to evaluate whether maintaining kidney function can prevent the development of CMBs.
