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Relationship between white matter hyperintensities and chronic kidney disease in patients with acute lacunar stroke
Lei Yang1, Ling Yu2, Youqi Kong1
1Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing, 100020, People's Republic of China.
Insights
Chronic kidney disease (CKD) is linked to moderate-severe periventricular white matter hyperintensities (PVWMH) in acute lacunar infarction patients. Deep white matter hyperintensities (DWMH) showed no such association, suggesting distinct underlying causes.
Area of Science:
- Neurology
- Nephrology
- Radiology
Background:
- Chronic kidney disease (CKD) is associated with white matter hyperintensities (WMH).
- Research on WMH and CKD in acute stroke patients is limited.
- The relationship between WMH severity and CKD in acute lacunar infarction requires further investigation.
Purpose of the Study:
- To investigate the association between the severity of white matter hyperintensities (WMH) and chronic kidney disease (CKD).
- To examine WMH in patients diagnosed with acute lacunar infarction.
- To differentiate the roles of periventricular WMH (PVWMH) and deep WMH (DWMH) in relation to CKD.
Main Methods:
- Cross-sectional study of 993 acute lacunar infarction patients.
- WMH severity (PVWMH and DWMH) dichotomized into mild (Fazekas 0-1) and moderate-severe (Fazekas 2-3) groups.
- Analysis included eGFR, proteinuria, vascular risk factors, and multivariable logistic regression.
Main Results:
- Moderate-severe PVWMH was associated with higher age, stroke history, higher serum creatinine, and presence of CKD.
- Lower eGFR was observed in patients with moderate-severe PVWMH.
- Moderate-severe DWMH was associated with higher age and stroke history, but not with eGFR or CKD.
- Multivariable analysis confirmed CKD (stage 2 and 3) independently associated with moderate-severe PVWMH, but not DWMH.
Conclusions:
- Chronic kidney disease is independently associated with moderate-severe periventricular white matter hyperintensities in acute lacunar infarction.
- No significant association was found between CKD and deep white matter hyperintensities.
- PVWMH and DWMH may arise from different pathophysiological mechanisms.
Background And Purpose:
Previous studies have revealed a relationship between chronic kidney disease (CKD) and white matter hyperintensities (WMH). However, studies on the WMH and CKD in acute stroke patients are rare, and the conclusion is consistent. Our study aimed to investigate the relationship between the severity of WMH and CKD in acute lacunar infarction patients.
Methods:
Consecutive acute lacunar infarction patients were recruited in this cross-sectional study. All patients were divided into two groups according to the severity of periventricular WMH (PVWMH) and deep WMH (DWMH). We dichotomized the severity of WMH (PVWMH and DWMH, separately) into mild group (Fazekas scores 0-1) and moderate-severe group (Fazekas scores 2-3). Estimated glomerular filtration rate (eGFR), proteinuria, vascular risk factors, and clinical features were compared between these two groups. Multivariable logistic regression analysis was used to investigate the association between the severity of WMH and risk factors.
Results:
A total of 993 acute lacunar infarction patients aged 25-95 years were enrolled. The proportions of participants presenting moderate-severe group PVWMH and DWMH were 46.6% and 38.6%, respectively. Patients with moderate-severe PVWMH had higher age (P < 0.001) and higher incidence of stroke history (P < 0.001) than those in mild group. The level of serum creatinine and the presence of CKD were significantly higher while the eGFR was significantly lower in patients with moderate-severe PVWMH than those with mild PVWMH. Patients with moderate-severe DWMH (n = 383) also had higher age (P < 0.001) and often had a history of stroke (P < 0.001). But the association between the severity of DWMH and eGFR was not found. Multivariable logistic regression analyses showed stage 2 CKD and stage 3 CKD were independently associated with moderate-severe PVWMH, but not DWMH.
Conclusions:
Our study demonstrates that CKD was independently associated with moderate-severe PVWMH in patients with acute lacunar infarction, but not DWMH. PVWMH and DWMH may have distinct pathophysiology.
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