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Miwa K, Toyoda K. Covert vascular brain injury in chronic kidney disease. Front Neurol 2022; 13:824503. [PMID: 35959397 PMCID: PMC9358355 DOI: 10.3389/fneur.2022.824503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic kidney disease (CKD) contributes to the increased risk of stroke and dementia. Accumulating evidence indicates that structural brain abnormalities, such as cerebral small vessel disease, including white matter hyperintensities, lacunes, perivascular spaces, and cerebral microbleeds, as well as brain atrophy, are common in patients with CKD. All of these imaging findings have been implicated in the development of stroke and dementia. The brain and kidney exhibit similar impairments and promote structural brain abnormalities due to shared vascular risk factors and similar anatomical and physiological susceptibility to vascular injury in patients with CKD. This indicates that kidney function has a significant effect on brain aging. However, as most results are derived from cross-sectional observational studies, the exact pathophysiology of structural brain abnormalities in CKD remains unclear. The early detection of structural brain abnormalities in CKD in the asymptomatic or subclinical phase (covert) should enable stroke risk prediction and guide clinicians on more targeted interventions to prevent stroke in patients with CKD. This article summarizes the currently available clinical evidence linking covert vascular brain injuries with CKD.
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Deng Y, Chen Z, Hu L, Xu Z, Hu J, Ma J, Yu J, Hu J, Li J, Xiong Q, Hong K. Decreased eGFR Is Associated With Ischemic Stroke in Patients With Dilated Cardiomyopathy. Clin Appl Thromb Hemost 2020; 25:1076029619866909. [PMID: 31373212 PMCID: PMC6829634 DOI: 10.1177/1076029619866909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is increasingly indicated as a cause of cardioembolic
syndrome, in particular, cardioembolic ischemia stroke. However, the potential risk
factors for stroke among DCM patients remain under investigated. DCM patients hospitalized
from June 2011 to June 2016 were included. The cases were defined as the group of DCM
patients with stroke compared with those without stroke. Clinical characteristic data were
collected and compared between the two groups including demographic data, complicated
diseases, echocardiography index, and laboratory parameters and estimated glomerular
filtration rate (eGFR). A multivariate logistic regression analysis model adjusted by sex
and age was used to explore the related risk factors for stroke in DCM patients. A total
of 779 hospitalized patients with DCM were included. Of these, 55 (7.1%) had experienced a
stroke. Significantly lower eGFR levels (68.03 ± 26.22 vs 79.88 ± 24.25 mL/min/1.73
m2, P = .001) and larger left atrial diameters (45.32 ± 7.79
vs 43.25 ± 7.11 mm, P = .04) were found in the group of patients having
DCM with stroke compared to those without stroke. When the eGFR was categorized as eGFR
>60, 30<eGFR≤ 60 and eGFR ≤ 30, there were more patients with 30<eGFR≤ 60 (30.9%
vs 17.7%) and eGFR≤ 30 (9.1% vs 3.3%) in the ischemic stroke group (P =
0.003). A multivariate logistic regression analysis model adjusted by sex and age showed
that 30 <eGFR≤60 (odds ratio [OR]: 2.07, 95% confidence interval [CI]: [1.05-4.07],
P = .035) and eGFR≤30 (OR: 4.04, 95% CI: [1.41-11.62],
P = .009) were statistically associated with ischemic stroke in
patients with DCM. It is concluded that decreased eGFR is significantly associated with an
increased risk of ischemic stroke in patients with DCM.
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Affiliation(s)
- Yuqing Deng
- 1 Department of Cardiovascular Medicine, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.,2 Department of Cardiovascular Medicine, the third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zhiqing Chen
- 1 Department of Cardiovascular Medicine, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Lili Hu
- 1 Department of Cardiovascular Medicine, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.,3 Nephrology Department, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zhenyan Xu
- 1 Department of Cardiovascular Medicine, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.,4 Jiangxi Key Laboratory of Molecular Medicine, Nanchang, Jiangxi, People's Republic of China
| | - Jinzhu Hu
- 1 Department of Cardiovascular Medicine, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Jianyong Ma
- 1 Department of Cardiovascular Medicine, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Jianhua Yu
- 1 Department of Cardiovascular Medicine, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Jianxin Hu
- 1 Department of Cardiovascular Medicine, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Juxiang Li
- 1 Department of Cardiovascular Medicine, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Qinmei Xiong
- 1 Department of Cardiovascular Medicine, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Kui Hong
- 1 Department of Cardiovascular Medicine, the second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.,4 Jiangxi Key Laboratory of Molecular Medicine, Nanchang, Jiangxi, People's Republic of China
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Song X, Li J, Hua Y, Wang C, Liu B, Liu C, Zhao Q, Zhang Z, Fang X, Wu J. Chronic Kidney Disease is Associated with Intracranial Artery Stenosis Distribution in the Middle-Aged and Elderly Population. J Atheroscler Thromb 2019; 27:245-254. [PMID: 31462617 PMCID: PMC7113140 DOI: 10.5551/jat.49569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aims: To investigate the association of chronic kidney disease (CKD) and intracranial artery stenosis (ICAS), as well as its effects on ICAS distribution in the middle-aged and elderly population. Methods: Data from the China Hypertension Survey in Beijing was analyzed. Estimated glomerular filtration rate (eGFR) was used to evaluate CKD, and ICAS was assessed by transcranial doppler. Clinical and biochemical variables were compared between the ICAS group and the non-ICAS group, as well as in different vascular distribution groups. Univariable and multivariable logistic regression analyses were introduced to demonstrate the association between CKD and ICAS. Results: A total of 3678 subjects were included in this study, with a mean age of 62 years old. Of which, 19.2% presented with decreased eGFR (eGFR < 60 ml/min/1.73 m2) and 17.4% for ICAS. The percentage of anterior circulation ICAS was 3.5 times than that of posterior circulation (10.9% vs. 3.1%). In multivariable regression analysis, eGFR < 45 ml/min/1.73 m2 was independently associated with ICAS after correction for covariates, odds ratio (OR) = 1.69, 95% confidence interval (CI) (1.08, 2.65); in particular, this association had a preference for posterior circulation but not anterior circulation ICAS with OR = 2.29, 95% CI (1.28, 4.07) and OR = 1.44, 95%CI (0.89, 2.33), respectively. Conclusion: Severe eGFR decline is associated with ICAS in the middle-aged and elderly population, and this correlation is more related to posterior circulation ICAS.
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Affiliation(s)
- Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Jun Li
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Yang Hua
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University
| | - Chunxiu Wang
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University
| | - Beibei Liu
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University
| | - Chunxiao Liu
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University
| | - Qiannan Zhao
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University
| | - Zhongying Zhang
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University
| | - Xianghua Fang
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University.,Center of Stroke, Beijing Institute for Brain Disorders
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Urine albumin-to-creatinine ratio and asymptomatic intracranial atherosclerotic stenosis in hypertensive patients. J Hum Hypertens 2019; 33:482-488. [PMID: 31000810 DOI: 10.1038/s41371-019-0201-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/04/2019] [Accepted: 03/28/2019] [Indexed: 11/08/2022]
Abstract
Intracranial atherosclerotic stenosis (ICAS) contributes to nearly 50% of stroke in China, especially in patients with hypertension. Urine albumin-to-creatinine ratio (ACR) has been related to stroke and other atherosclerotic cardiovascular diseases. However, there is limited information about the association of ACR and early impairment of cerebral vessels. Hereby we assessed the association of ICAS with ACR, estimated glomerular filtration rate (eGFR), and dipstick proteinuria in a stroke-free hypertensive population. We included 889 hypertension patients aged ≥60 years without prior stroke. Computed tomography angiography was performed to detect ICAS. ACR and dipstick proteinuria were tested from a random spot urine. eGFR was calculated using the CKD-EPI equation. Logistic regression was carried out to analyze the association of renal function with the presence, extent, and lesion number of ICAS. Elevated ACR (≥30 mg/g) was associated with ICAS after adjustment of confounding factors (odds ratio (OR) = 1.66, 95% confidence interval (CI): 1.21-2.29). Patients with elevated ACR were more prone to develop moderate-to-severe stenosis (OR = 1.57, 95% CI: 1.16-2.14) and more lesions (OR = 1.58, 95% CI: 1.16-2.15). Such association was independent of previously identified cardiovascular risk factors. No significant association was detected between ICAS and dipstick proteinuria or eGFR after adjustment. Our findings suggested that elevated ACR was associated with asymptomatic ICAS in an aged stroke-free hypertensive population.
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