Impaired Kidney Function Small Vessel Disease Markers and Its Association with Periventricular White Matter Hyperintensities
Ricardo Murguia Fuentes1, Farid Khasiyev2, Kursat Gurel3, Antonio Spagnolo-Allende3, Salwa Rahman3, Pedro Gabriel Paiva Bueno3, Jose Murguia Fuentes4, Randolph Marshall5, Mitchell Elkind5, Jose Gutierrez5
1LSU Health Shreveport, 2SLUCare Academic Pavilion, Department of Neurology, 3Columbia University Medical Center, 4Instituto Tecnologico Autonomo de Mexico, 5Columbia University
Objective:
We hypothesize that impaired kidney function is differentially associated with brain markers of SVD, and the association is greater with SVD markers restricted to deep, penetrating arteries.
Background:
Small vessel disease (SVD) is a condition associated with aging and vascular risk factors to which the brain and kidney are susceptible. However, whether kidney dysfunction may directly contribute to brain SVD as opposed to both organs being affected as an epiphenomenon of aging is less clear.
Design/Methods:
We leveraged existing data from our institution stroke registry. Odds ratio (OR), estimate, confidence intervals (CI), and p values were calculated. We rated visually the presence an anatomical location of cerebral microbleeds and chronic lacunar infarcts and used the Fazekas scale to semi-quantitate white matter hyperintensities. We created linear regression models adjusted for age, sex, race/ethnicity and vascular risk factors to evaluate the relationship between kidney function (defined as self-reported chronic kidney disease or creatinine on admission).
Results:
We included 973 patients (mean age 65±16 years, 51 % female). The prevalence of self-reported CKD/ESRD was 14% and the mean creatinine on admission was 1.61±2.04 mg/dl. The prevalence of chronic brain infarct was 40%, cerebral microbleeds 24%, and all had some degree of white matter hyperintensity. Calculated OR for deep location CMB in CKD/ESRD patients was 1.83 (p= 0.076). Beta estimate for periventricular WMH was 0.40 (p= 0.031) in CKD/ESRD patients and 0.51 (p= ≤0.01) in relation to the creatinine levels on admission.
Conclusions:
There is association between previous history of CKD-ESRD and creatinine levels on admission with periventricular WMH. These data also hint a possible association between CMB of deep location with history of CKD-ESRD, but a bigger sample is required for significance.