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Tamura MK, Pajewski NM, Bryan RN, Weiner DE, Diamond M, Van Buren P, Taylor A, Beddhu S, Rosendorff C, Jahanian H, Zaharchuk G. Chronic kidney disease, cerebral blood flow, and white matter volume in hypertensive adults. Neurology 2016; 86:1208-16. [PMID: 26920359 PMCID: PMC4818564 DOI: 10.1212/wnl.0000000000002527] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/14/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To determine the relation between markers of kidney disease-estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR)-with cerebral blood flow (CBF) and white matter volume (WMV) in hypertensive adults. METHODS We used baseline data collected from 665 nondiabetic hypertensive adults aged ≥50 years participating in the Systolic Blood Pressure Intervention Trial (SPRINT). We used arterial spin labeling to measure CBF and structural 3T images to segment tissue into normal and abnormal WMV. We used quantile regression to estimate the association between eGFR and UACR with CBF and abnormal WMV, adjusting for sociodemographic and clinical characteristics. RESULTS There were 218 participants (33%) with eGFR <60 mL/min/1.73 m(2) and 146 participants (22%) with UACR ≥30 mg/g. Reduced eGFR was independently associated with higher adjusted median CBF, but not with abnormal WMV. Conversely, in adjusted analyses, there was a linear independent association between UACR and larger abnormal WMV, but not with CBF. Compared to participants with neither marker of CKD (eGFR ≥60 mL/min/1.73 m(2) and UACR <30 mg/g), median CBF was 5.03 mL/100 g/min higher (95% confidence interval [CI] 0.78, 9.29) and abnormal WMV was 0.63 cm(3) larger (95% CI 0.08, 1.17) among participants with both markers of CKD (eGFR <60 mL/min/1.73 m(2) and UACR ≥30 mg/g). CONCLUSIONS Among nondiabetic hypertensive adults, reduced eGFR was associated with higher CBF and higher UACR was associated with larger abnormal WMV.
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Affiliation(s)
- Manjula Kurella Tamura
- From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY.
| | - Nicholas M Pajewski
- From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY
| | - R Nick Bryan
- From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY
| | - Daniel E Weiner
- From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY
| | - Matthew Diamond
- From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY
| | - Peter Van Buren
- From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY
| | - Addison Taylor
- From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY
| | - Srinivasan Beddhu
- From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY
| | - Clive Rosendorff
- From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY
| | - Hesamoddin Jahanian
- From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY
| | - Greg Zaharchuk
- From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY
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Sandsmark DK, Messé SR, Zhang X, Roy J, Nessel L, Lee Hamm L, He J, Horwitz EJ, Jaar BG, Kallem RR, Kusek JW, Mohler ER, Porter A, Seliger SL, Sozio SM, Townsend RR, Feldman HI, Kasner SE. Proteinuria, but Not eGFR, Predicts Stroke Risk in Chronic Kidney Disease: Chronic Renal Insufficiency Cohort Study. Stroke 2015; 46:2075-80. [PMID: 26130097 PMCID: PMC4519405 DOI: 10.1161/strokeaha.115.009861] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Chronic kidney disease is associated with an increased risk of cardiovascular events. However, the impact of chronic kidney disease on cerebrovascular disease is less well understood. We hypothesized that renal function severity would be predictive of stroke risk, independent of other vascular risk factors. METHODS The study population included 3939 subjects enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study, a prospective observational cohort. Stroke events were reported by participants and adjudicated by 2 vascular neurologists. Cox proportional hazard models were used to compare measures of baseline renal function with stroke events. Multivariable analysis was performed to adjust for key covariates. RESULTS In 3939 subjects, 143 new stroke events (0.62 events per 100 person-years) occurred over a mean follow-up of 6.4 years. Stroke risk was increased in subjects who had worse baseline measurements of renal function (estimated glomerular filtration rate and total proteinuria or albuminuria). When adjusted for variables known to influence stroke risk, total proteinuria or albuminuria, but not estimated glomerular filtration rate, were associated with an increased risk of stroke. Treatment with blockers of the renin-angiotensin system did not decrease stroke risk in individuals with albuminuria. CONCLUSIONS Proteinuria and albuminuria are better predictors of stroke risk in patients with chronic kidney disease than estimated glomerular filtration rate. The impact of therapies targeting proteinuria/albuminuria in individuals with chronic kidney disease on stroke prevention warrants further investigation.
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Affiliation(s)
- Danielle K Sandsmark
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.).
| | - Steven R Messé
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Xiaoming Zhang
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Jason Roy
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Lisa Nessel
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Lotuce Lee Hamm
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Jiang He
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Edward J Horwitz
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Bernard G Jaar
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Radhakrishna R Kallem
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - John W Kusek
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Emile R Mohler
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Anna Porter
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Stephen L Seliger
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Stephen M Sozio
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Raymond R Townsend
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Harold I Feldman
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
| | - Scott E Kasner
- From the Department of Neurology (D.K.S., S.R.M., S.E.K.), Renal, Electrolyte, and Hypertension Division (R.R.K., R.R.T.) and Division of Vascular Medicine (E.R.M.), Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (X.Z., J.R., L.N., H.I.F.); Department of Medicine, Tulane University, New Orleans, LA (L.L.H.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Metrohealth, Cleveland, OH (E.J.H.); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (B.G.J.); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.W.K.); Department of Nephrology, University of Illinois, Chicago (A.P.); Department of Medicine, University of Maryland, Baltimore (S.L.S.); and Department of Medicine, Johns Hopkins University, Baltimore, MD (S.M.S.)
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Sedaghat S, Cremers LGM, de Groot M, Hoorn EJ, Hofman A, van der Lugt A, Franco OH, Vernooij MW, Dehghan A, Ikram MA. Kidney function and microstructural integrity of brain white matter. Neurology 2015; 85:154-61. [PMID: 26085601 DOI: 10.1212/wnl.0000000000001741] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/16/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To investigate the association of kidney function with white matter microstructural integrity. METHODS We included 2,726 participants with a mean age of 56.6 years (45% men) from the population-based Rotterdam Study. Albumin-to-creatinine ratio, and estimated glomerular filtration rate (eGFR), using serum cystatin C (eGFRcys) and creatinine (eGFRcr), were measured to evaluate kidney function. Diffusion-MRI was used to assess microstructural integrity of the normal-appearing white matter. Multiple linear regression models, adjusted for macrostructural MRI markers and cardiovascular risk factors, were used to model the association of kidney function with white matter microstructure. RESULTS Participants had average eGFRcr of 86.1 mL/min/1.73 m(2), average eGFRcys of 86.2 mL/min/1.73 m(2), and median albumin-to-creatinine ratio of 3.4 mg/g. Lower eGFRcys was associated with worse global white matter microstructural integrity, reflected as lower fractional anisotropy (standardized difference per SD: -0.053, 95% confidence interval [CI]: -0.092, -0.014) and higher mean diffusivity (0.036, 95% CI: 0.001, 0.070). Similarly, higher albumin-to-creatinine ratio was associated with lower fractional anisotropy (-0.044, 95% CI: -0.078, -0.011). There was no linear association between eGFRcr and white matter integrity. Subgroup analyses showed attenuation of the associations after excluding subjects with hypertension. The associations with global diffusion tensor imaging measures did not seem to be driven by particular tracts, but rather spread across multiple tracts in various brain regions. CONCLUSIONS Reduced kidney function is associated with worse white matter microstructural integrity. Our findings highlight the importance for clinicians to consider concomitant macro- and microstructural changes of the brain in patients with impaired kidney function.
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Affiliation(s)
- Sanaz Sedaghat
- From the Departments of Epidemiology (S.S., L.G.M.C., M.d.G., A.H., O.H.F., M.W.V., A.D., M.A.I.), Radiology (L.G.M.C., M.d.G., A.v.d.L., M.W.V., M.A.I.), Medical informatics (M.d.G.), Internal Medicine (E.J.H.), and Neurology (M.A.I.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lotte G M Cremers
- From the Departments of Epidemiology (S.S., L.G.M.C., M.d.G., A.H., O.H.F., M.W.V., A.D., M.A.I.), Radiology (L.G.M.C., M.d.G., A.v.d.L., M.W.V., M.A.I.), Medical informatics (M.d.G.), Internal Medicine (E.J.H.), and Neurology (M.A.I.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marius de Groot
- From the Departments of Epidemiology (S.S., L.G.M.C., M.d.G., A.H., O.H.F., M.W.V., A.D., M.A.I.), Radiology (L.G.M.C., M.d.G., A.v.d.L., M.W.V., M.A.I.), Medical informatics (M.d.G.), Internal Medicine (E.J.H.), and Neurology (M.A.I.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ewout J Hoorn
- From the Departments of Epidemiology (S.S., L.G.M.C., M.d.G., A.H., O.H.F., M.W.V., A.D., M.A.I.), Radiology (L.G.M.C., M.d.G., A.v.d.L., M.W.V., M.A.I.), Medical informatics (M.d.G.), Internal Medicine (E.J.H.), and Neurology (M.A.I.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- From the Departments of Epidemiology (S.S., L.G.M.C., M.d.G., A.H., O.H.F., M.W.V., A.D., M.A.I.), Radiology (L.G.M.C., M.d.G., A.v.d.L., M.W.V., M.A.I.), Medical informatics (M.d.G.), Internal Medicine (E.J.H.), and Neurology (M.A.I.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Aad van der Lugt
- From the Departments of Epidemiology (S.S., L.G.M.C., M.d.G., A.H., O.H.F., M.W.V., A.D., M.A.I.), Radiology (L.G.M.C., M.d.G., A.v.d.L., M.W.V., M.A.I.), Medical informatics (M.d.G.), Internal Medicine (E.J.H.), and Neurology (M.A.I.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- From the Departments of Epidemiology (S.S., L.G.M.C., M.d.G., A.H., O.H.F., M.W.V., A.D., M.A.I.), Radiology (L.G.M.C., M.d.G., A.v.d.L., M.W.V., M.A.I.), Medical informatics (M.d.G.), Internal Medicine (E.J.H.), and Neurology (M.A.I.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Meike W Vernooij
- From the Departments of Epidemiology (S.S., L.G.M.C., M.d.G., A.H., O.H.F., M.W.V., A.D., M.A.I.), Radiology (L.G.M.C., M.d.G., A.v.d.L., M.W.V., M.A.I.), Medical informatics (M.d.G.), Internal Medicine (E.J.H.), and Neurology (M.A.I.), Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Abbas Dehghan
- From the Departments of Epidemiology (S.S., L.G.M.C., M.d.G., A.H., O.H.F., M.W.V., A.D., M.A.I.), Radiology (L.G.M.C., M.d.G., A.v.d.L., M.W.V., M.A.I.), Medical informatics (M.d.G.), Internal Medicine (E.J.H.), and Neurology (M.A.I.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- From the Departments of Epidemiology (S.S., L.G.M.C., M.d.G., A.H., O.H.F., M.W.V., A.D., M.A.I.), Radiology (L.G.M.C., M.d.G., A.v.d.L., M.W.V., M.A.I.), Medical informatics (M.d.G.), Internal Medicine (E.J.H.), and Neurology (M.A.I.), Erasmus University Medical Center, Rotterdam, the Netherlands
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