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103
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Steinicke R, Gaertner B, Grittner U, Schmidt W, Dichgans M, Heuschmann PU, Tanislav C, Putaala J, Kaps M, Endres M, Schmidt R, Fazekas F, Norrving B, Rolfs A, Martus P, Tatlisumak T, Enzinger C, Jungehulsing GJ. Kidney Function and White Matter Disease in Young Stroke Patients. Stroke 2012; 43:2382-8. [DOI: 10.1161/strokeaha.111.645713] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Impaired kidney function is thought to be associated with small vessel disease, outcome, and mortality in the general stroke population. Data are limited regarding young patients. The aim of this study was to investigate the association of kidney function and white matter hyperintensities (WMHs) in young patients with first ischemic stroke.
Methods—
We analyzed 2500 young (18–55 years) patients with first-ever ischemic stroke from the prospective observational Stroke in Young Fabry Patients (SIFAP1) study with available MRI data on WMH. Of these, 2009 had available data concerning estimated glomerular filtration rate (eGFR). Kidney function was expressed as eGFR by the Modification of Diet in Renal Disease method. Deep WMHs on MRI were classified by the Fazekas score. Multivariate analysis was performed using a regression model with random effects.
Results—
Mean eGFR was 96.7 mL/min in those with WMH Grade 0 to 1 (none to mild), 90.7 mL/min in WMH Grade 2 (moderate), and 89 mL/min in WMH Grade 3 (severe). Univariate analysis revealed WMH to be associated with age (
P
<0.001), hypertension (
P
<0.001), cardiovascular disease (
P
=0.015), overweight (body mass index >25 kg/m
2
;
P
=0.013), current smoking (
P
=0.044), and eGFR (
P
=0.009). In multivariate analysis, age, hypertension, and eGFR remained associated with WMH severity.
Conclusions—
In young patients with acute ischemic stroke, lower eGFR values in the normal range are associated with the presence of moderate to severe WMH.
Clinical Trial Registration—
URL:
http://clinicaltrials.gov
. Unique Identifier: NCT00414583.
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Affiliation(s)
- Robert Steinicke
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Beate Gaertner
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Ulrike Grittner
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Wolf Schmidt
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Martin Dichgans
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Peter U. Heuschmann
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Christian Tanislav
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Jukka Putaala
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Manfred Kaps
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Matthias Endres
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Reinhold Schmidt
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Franz Fazekas
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Bo Norrving
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Arndt Rolfs
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Peter Martus
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Turgut Tatlisumak
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Christian Enzinger
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
| | - Gerhard Jan Jungehulsing
- From the Center for Stroke Research Berlin (R.S., W.S., P.U.H., M.E., G.J.J.) and Department of Biostatistics and Clinical Epidemiology (B.G., U.G., P.M.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Justus Liebig University, Giessen, Germany (C.T., M.K.); Helsinki University Central Hospital, Helsinki, Finland (J.P., T.T.); Medical University of Graz, Graz, Austria (R.Sc., F.F., C.E.); Institute for Stroke and Dementia Research, Klinikum Großhadern, LMU, München,
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112
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Oksala NK, Salonen T, Strandberg T, Oksala A, Pohjasvaara T, Kaste M, Karhunen PJ, Erkinjuntti T. Cerebral Small Vessel Disease and Kidney Function Predict Long-Term Survival in Patients With Acute Stroke. Stroke 2010; 41:1914-20. [DOI: 10.1161/strokeaha.110.587352] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Niku K.J. Oksala
- From the Division of Vascular Surgery (N.K.J.O.), Department of Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland; the School of Medicine (N.K.J.O., A.O., P.J.K.), Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland; the Department of Medicine (T. Salonen), Tampere University Hospital, Tampere, Finland; the Institute of Health Sciences/Geriatrics (T. Strandberg), University of Oulu and
| | - Tapani Salonen
- From the Division of Vascular Surgery (N.K.J.O.), Department of Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland; the School of Medicine (N.K.J.O., A.O., P.J.K.), Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland; the Department of Medicine (T. Salonen), Tampere University Hospital, Tampere, Finland; the Institute of Health Sciences/Geriatrics (T. Strandberg), University of Oulu and
| | - Timo Strandberg
- From the Division of Vascular Surgery (N.K.J.O.), Department of Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland; the School of Medicine (N.K.J.O., A.O., P.J.K.), Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland; the Department of Medicine (T. Salonen), Tampere University Hospital, Tampere, Finland; the Institute of Health Sciences/Geriatrics (T. Strandberg), University of Oulu and
| | - Anni Oksala
- From the Division of Vascular Surgery (N.K.J.O.), Department of Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland; the School of Medicine (N.K.J.O., A.O., P.J.K.), Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland; the Department of Medicine (T. Salonen), Tampere University Hospital, Tampere, Finland; the Institute of Health Sciences/Geriatrics (T. Strandberg), University of Oulu and
| | - Tarja Pohjasvaara
- From the Division of Vascular Surgery (N.K.J.O.), Department of Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland; the School of Medicine (N.K.J.O., A.O., P.J.K.), Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland; the Department of Medicine (T. Salonen), Tampere University Hospital, Tampere, Finland; the Institute of Health Sciences/Geriatrics (T. Strandberg), University of Oulu and
| | - Markku Kaste
- From the Division of Vascular Surgery (N.K.J.O.), Department of Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland; the School of Medicine (N.K.J.O., A.O., P.J.K.), Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland; the Department of Medicine (T. Salonen), Tampere University Hospital, Tampere, Finland; the Institute of Health Sciences/Geriatrics (T. Strandberg), University of Oulu and
| | - Pekka J. Karhunen
- From the Division of Vascular Surgery (N.K.J.O.), Department of Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland; the School of Medicine (N.K.J.O., A.O., P.J.K.), Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland; the Department of Medicine (T. Salonen), Tampere University Hospital, Tampere, Finland; the Institute of Health Sciences/Geriatrics (T. Strandberg), University of Oulu and
| | - Timo Erkinjuntti
- From the Division of Vascular Surgery (N.K.J.O.), Department of Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland; the School of Medicine (N.K.J.O., A.O., P.J.K.), Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland; the Department of Medicine (T. Salonen), Tampere University Hospital, Tampere, Finland; the Institute of Health Sciences/Geriatrics (T. Strandberg), University of Oulu and
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