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Renal Dysfunction Is Associated with Middle Cerebral Artery Pulsatility Index and Total Burden of Cerebral Small
Eung-Joon Lee1, Hae-Bong Jeong2, Jeonghoon Bae3
1Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea, lejoon0824@gmail.com.
Insights
Renal dysfunction is linked to increased cerebral small vessel disease (cSVD) burden and higher pulsatility index (PI) in the middle cerebral artery (MCA). Kidney disease patients may benefit from TCD screening for high PI.
Area of Science:
- Neurology
- Nephrology
- Vascular Medicine
Background:
- Renal dysfunction contributes to systemic arterial stiffness and increases the risk of cerebral small vessel disease (cSVD) and stroke.
- It is crucial to understand how renal dysfunction impacts cerebral hemodynamics and cSVD.
- This study investigates the relationship between renal function, cerebral blood flow resistance, and cSVD burden.
Purpose of the Study:
- To examine the effect of renal dysfunction on cerebral hemodynamics.
- To assess the association between renal dysfunction and the burden of cerebral small vessel disease (cSVD).
- To determine the relationship between renal function and pulsatility index (PI) in the middle cerebral artery (MCA).
Main Methods:
- A cohort of 283 patients with lacunar infarction and no major intracranial stenosis were analyzed.
- Patients were categorized into groups based on renal function (eGFR <60 mL/min/1.73 m2) and controls (eGFR ≥60 mL/min/1.73 m2).
- Transcranial Doppler (TCD) ultrasound was used to measure the pulsatility index (PI) of the MCA, and MRI was used to assess cSVD burden.
Main Results:
- Patients with renal dysfunction (26.1%) were older and had higher prevalence of comorbidities.
- Renal dysfunction was significantly associated with higher distal cerebrovascular flow resistance (increased PI) and a greater MRI burden of cSVD.
- A significant inverse relationship was observed between PI and eGFR.
Conclusions:
- Renal dysfunction is an independent predictor of a high pulsatility index (PI) in the middle cerebral artery (MCA).
- Renal dysfunction exacerbates systemic and cerebral arterial stiffness, increasing the cSVD burden.
- Noninvasive screening for high PI using TCD in patients with kidney disease is recommended.
Background And Purpose:
Renal dysfunction is known to affect vasculature and lead to systemic arterial stiffness. It also independently increases the risk of cerebral small vessel disease (cSVD) and stroke. We aimed to examine the effect of renal dysfunction on cerebral hemodynamics and the burden of cSVD.
Methods:
Of the 412 patients admitted to Seoul National University Hospital, between May 2015 and 2019, with lacunar infarction and no major intracranial arterial stenosis observed on magnetic resonance angiography, we included 283 patients who had undergone a transcranial Doppler (TCD) ultrasound after 72 h of stroke onset. The patients were divided into renal dysfunction (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 at admission) and control (eGFR ≥60 mL/min/1.73 m2) groups. We investigated the correlations between renal function, the pulsatility index (PI), and the total MRI burden of cSVD. Furthermore, multivariate analysis was performed to assess the association between renal dysfunction and the PI of the middle cerebral artery (MCA) measured through TCD ultrasound.
Results:
Among the total patients, 74 (26.1%) had renal dysfunction (eGFR <60 mL/min/1.73 m2 at admission). Patients with renal dysfunction were significantly older, showed higher pulse pressure, and had a higher prevalence of hypertension, diabetes mellitus, and coronary artery disease. Renal dysfunction was significantly associated with higher distal cerebrovascular flow resistance (median PI 1.12, interquartile range [IQR]: 0.85-1.57 vs. controls 0.84, IQR: 0.54-1.22; p < 0.001). Also, patients with renal dysfunction had a significantly higher total MRI burden of cSVD (median cSVD score 2, IQR: 1-3 vs. controls median score 1, IQR: 0-2; p < 0.001). There was an inverse proportional relationship between the PI and eGFR. Finally, multivariate analysis showed renal dysfunction (adjusted odds ratio: 4.516, 95% confidence interval: 1.051-20.292) and older age (adjusted odds ratio: 1.076, 95% confidence interval: 1.038-1.114) as independent predictors of a high PI.
Conclusions:
Renal dysfunction is independently associated with a high PI of MCA. Renal dysfunction leads to systemic arterial stiffness including stiffness in cerebral arteries, thus increasing the burden of cSVD. Therefore, noninvasive screening for high PI by TCD in kidney failure patients might be helpful.
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