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Stulberg EL, Sachdev PS, Murray AM, Cramer SC, Sorond FA, Lakshminarayan K, Sabayan B. Post-Stroke Brain Health Monitoring and Optimization: A Narrative Review. J Clin Med 2023; 12:7413. [PMID: 38068464 PMCID: PMC10706919 DOI: 10.3390/jcm12237413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 01/22/2024] Open
Abstract
Significant advancements have been made in recent years in the acute treatment and secondary prevention of stroke. However, a large proportion of stroke survivors will go on to have enduring physical, cognitive, and psychological disabilities from suboptimal post-stroke brain health. Impaired brain health following stroke thus warrants increased attention from clinicians and researchers alike. In this narrative review based on an open timeframe search of the PubMed, Scopus, and Web of Science databases, we define post-stroke brain health and appraise the body of research focused on modifiable vascular, lifestyle, and psychosocial factors for optimizing post-stroke brain health. In addition, we make clinical recommendations for the monitoring and management of post-stroke brain health at major post-stroke transition points centered on four key intertwined domains: cognition, psychosocial health, physical functioning, and global vascular health. Finally, we discuss potential future work in the field of post-stroke brain health, including the use of remote monitoring and interventions, neuromodulation, multi-morbidity interventions, enriched environments, and the need to address inequities in post-stroke brain health. As post-stroke brain health is a relatively new, rapidly evolving, and broad clinical and research field, this narrative review aims to identify and summarize the evidence base to help clinicians and researchers tailor their own approach to integrating post-stroke brain health into their practices.
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Affiliation(s)
- Eric L. Stulberg
- Department of Neurology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW 2052, Australia;
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Minneapolis, MN 55415, USA;
- Department of Medicine, Geriatrics Division, Hennepin Healthcare Research Institute, Minneapolis, MN 55404, USA
| | - Steven C. Cramer
- Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA;
- California Rehabilitation Institute, Los Angeles, CA 90067, USA
| | - Farzaneh A. Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Behnam Sabayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
- Department of Neurology, Hennepin Healthcare Research Institute, Minneapolis, MN 55404, USA
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2
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Zoccali C, Mark PB, Sarafidis P, Agarwal R, Adamczak M, Bueno de Oliveira R, Massy ZA, Kotanko P, Ferro CJ, Wanner C, Burnier M, Vanholder R, Mallamaci F, Wiecek A. Diagnosis of cardiovascular disease in patients with chronic kidney disease. Nat Rev Nephrol 2023; 19:733-746. [PMID: 37612381 DOI: 10.1038/s41581-023-00747-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/25/2023]
Abstract
Patients with chronic kidney disease (CKD) are at high risk of cardiovascular disease (CVD) and cardiovascular death. Identifying and monitoring cardiovascular complications and hypertension is important for managing patients with CKD or kidney failure and transplant recipients. Biomarkers of myocardial ischaemia, such as troponins and electrocardiography (ECG), have limited utility for diagnosing cardiac ischaemia in patients with advanced CKD. Dobutamine stress echocardiography, myocardial perfusion scintigraphy and dipyridamole stress testing can be used to detect coronary disease in these patients. Left ventricular hypertrophy and left ventricular dysfunction can be detected and monitored using various techniques with differing complexity and cost, including ECG, echocardiography, nuclear magnetic resonance, CT and myocardial scintigraphy. Atrial fibrillation and other major arrhythmias are common in all stages of CKD, and ambulatory heart rhythm monitoring enables precise time profiling of these disorders. Screening for cerebrovascular disease is only indicated in asymptomatic patients with autosomal dominant polycystic kidney disease. Standardized blood pressure is recommended for hypertension diagnosis and treatment monitoring and can be complemented by ambulatory blood pressure monitoring. Judicious use of these diagnostic techniques may assist clinicians in detecting the whole range of cardiovascular alterations in patients with CKD and enable timely treatment of CVD in this high-risk population.
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Affiliation(s)
- Carmine Zoccali
- Renal Research Institute, New York, NY, USA.
- Institute of Biology and Molecular Genetics (BIOGEM), Ariano Irpino, Italy.
- Associazione Ipertensione Nefrologia e Trapianto Renale (IPNET) c/o Nefrologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy.
| | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rajiv Agarwal
- Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Marcin Adamczak
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Rodrigo Bueno de Oliveira
- Department of Internal Medicine (Nephrology), School of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
| | - Ziad A Massy
- Ambroise Paré University Hospital, APHP, Boulogne Billancourt/Paris, Billancourt, France
- INSERM U-1018, Centre de recherche en épidémiologie et santé des populations (CESP), Equipe 5, Paris-Saclay University (PSU), Paris, France
- University of Paris Ouest-Versailles-Saint-Quentin-en-Yvelines (UVSQ), FCRIN INI-CRCT, Villejuif, France
| | - Peter Kotanko
- Renal Research Institute, LLC Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles J Ferro
- Department of Renal Medicine, University Hospitals Birmingham, Birmingham, UK
| | - Christoph Wanner
- Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital, Ghent, Belgium
| | - Francesca Mallamaci
- Nephrology and Transplantation Unit, Grande Ospedale Metropolitano Reggio Cal and CNR-IFC, Reggio Calabria, Italy
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
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Noor ST, Bota SE, Clarke AE, Petrcich W, Kelly D, Knoll G, Hundemer GL, Canney M, Tanuseputro P, Sood MM. Stroke Subtype Among Individuals With Chronic Kidney Disease. Can J Kidney Health Dis 2023; 10:20543581231203046. [PMID: 37841343 PMCID: PMC10576427 DOI: 10.1177/20543581231203046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/18/2023] [Indexed: 10/17/2023] Open
Abstract
Background It is widely accepted that there is a stepwise increase in the risk of acute ischemic stroke with chronic kidney disease (CKD). However, whether the risk of specific ischemic stroke subtypes varies with CKD remains unclear. Objective To assess the association between ischemic stroke subtypes (cardioembolic, arterial, lacunar, and other) classified using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and CKD stage. Design retrospective cohort study. Setting Ontario, Canada. Patients A total of 17 434 adults with an acute ischemic stroke in Ontario, Canada between April 1, 2002 and March 31, 2013, with an estimated glomerular filtration rate (eGFR) measurement or receipt of maintenance dialysis captured in a stroke registry were included. Measurements Kidney function categorized as an eGFR of ≥60, 30-59, <30 mL/min/1.73 m2, or maintenance dialysis. Ischemic stroke classified by TOAST included arterial, cardioembolic, lacunar, and other (dissection, prothrombotic state, cortical vein/sinus thrombosis, and vasculitis) types of strokes. Methods Adjusted regression models. Results In our cohort, 58.9% had an eGFR of ≥60, 34.7% an eGFR of 30-59, 6.0% an eGFR of <30 and 0.5% were on maintenance dialysis (mean age of 73 years; 48% women). Cardioembolic stroke was more common in patients with non-dialysis-dependant CKD (eGFR 30-59: 50.4%, adjusted odds ratio [OR] 1.20, 95% confidence interval [CI]: 1.02, 1.44; eGFR<30: 50.6%, OR 1.21, 95% CI: 1.02, 1.44), whereas lacunar stroke was less common (eGFR 30-59: 22.7% OR 0.85, 95% CI: 0.77, 0.93; eGFR <30: 0.73, 95% CI: 0.61, 0.88) compared with those with an eGFR ≥60. In stratified analyses by age and CKD, lacunar strokes were more frequent in those aged less than 65 years, whereas cardioembolic was higher in those aged 65 years and above. Limitations TOAST classification was not captured for all patients. Conclusion Non-dialysis CKD was associated with a higher risk of cardioembolic stroke, whereas an eGFR ≥60 mL/min/1.73 m2 was associated with a higher risk of lacunar stroke. Detailed stroke subtyping in CKD may therefore provide mechanistic insights and refocus treatment strategies in this high-risk population.
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Affiliation(s)
- Salmi T. Noor
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
| | - Sarah E. Bota
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Anna E. Clarke
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | | | - Dearbhla Kelly
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Greg Knoll
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Gregory L. Hundemer
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
| | - Mark Canney
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
| | - Peter Tanuseputro
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Manish M. Sood
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
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Kourtidou C, Tziomalos K. Epidemiology and Risk Factors for Stroke in Chronic Kidney Disease: A Narrative Review. Biomedicines 2023; 11:2398. [PMID: 37760839 PMCID: PMC10525494 DOI: 10.3390/biomedicines11092398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have a higher risk ofboth ischemic and hemorrhagic stroke. This association appears to be partly independent from the higher prevalence of established risk factors for stroke in patients with CKD, including hypertension and atrial fibrillation. In the present review we aim to discuss the impact of CKD on the risk of stroke and stroke-related consequences, and explore the pathophysiology underpinning the increased risk of stroke in patients with CKD. We cover the clinical association between renal dysfunction and cerebrovascular disease including stroke, silent brain infarct, cerebral small vessel disease, microbleeds, and white matter hyperintensity, and discuss the underlying mechanisms.
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Affiliation(s)
- Christodoula Kourtidou
- Department of Nephrology, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece;
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
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5
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Kelly DM, Rothwell PM. Disentangling the Relationship Between Chronic Kidney Disease and Cognitive Disorders. Front Neurol 2022; 13:830064. [PMID: 35280286 PMCID: PMC8914950 DOI: 10.3389/fneur.2022.830064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease (CKD) is a rapidly rising global health burden that affects nearly 40% of older adults. Epidemiologic data suggest that individuals at all stages of chronic kidney disease (CKD) have a higher risk of developing cognitive disorders and dementia, and thus represent a vulnerable population. It is currently unknown to what extent this risk may be attributable to a clustering of traditional risk factors such as hypertension and diabetes mellitus leading to a high prevalence of both symptomatic and subclinical ischaemic cerebrovascular lesions, or whether other potential mechanisms, including direct neuronal injury by uraemic toxins or dialysis-specific factors could also be involved. These knowledge gaps may lead to suboptimal prevention and treatment strategies being implemented in this group. In this review, we explore the mechanisms of susceptibility and risk in the relationship between CKD and cognitive disorders.
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Affiliation(s)
- Dearbhla M. Kelly
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Peter M. Rothwell
- Wolfson Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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Zaki HM, Sliem H, Ibrahim HR, Yassine IA. Neurological Soft Signs in Non-diabetic End Stage Renal Disease Patients: Evaluation and Prediction. Neurol Res 2022; 44:645-650. [PMID: 35048798 DOI: 10.1080/01616412.2022.2028958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients on hemodialysis suffer from several serious complex neurological complications resulting in significant disability. Early detection of these complications during the asymptomatic phase may consent to early intervention to prevent or minimize the disability. To assess and predict neurological soft signs (NSS) in non-diabetic end-stage renal disease (ESRD) patients on hemodialysis (HD) who do not suffer any apparent neurological symptoms. An analytical, cross-sectional study was done in Hemodialysis units in the Suez Canal University Hospitals. 96 ESRD adult patients on hemodialysis are exposed to: Medical history was taken via personal interview, laboratory tests, and clinical assessment of NSS using Heidelberg scale, and brain CT was done for 50 high-risk patients (hypertensive or those on dialysis for more than 5 years) to detect the presence of any probable neuro-radiological brain abnormalities. 79.2% of our studied ESRD patients on HD had positive NSS with a mean value of total score 8.5 ± 5.9. Strong positive correlations were present between NSS and Hb levels, duration of hemodialysis, and hypertension. CT had revealed no abnormality. NSS represent a reliable, affordable tool for regular bedside assessment of ESRD patients with HD who do not suffer any neurological symptoms for early detection of asymptomatic neurological lesions, especially since the CT brain scan did not show such changes early. The duration of hemodialysis, Hb level, and hypertension were independent predictors for the occurrence of silent neurological lesions in ESRD patients.
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Affiliation(s)
- Heba M Zaki
- Department of Internal Medicine- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hamdy Sliem
- Department of Internal Medicine- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Heba R Ibrahim
- Department of Diagnostic Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Imane A Yassine
- Department of Neurology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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7
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Kelly DM, Pendlebury ST, Rothwell PM. Associations of Chronic Kidney Disease With Dementia Before and After Transient Ischemic Attack and Stroke: Population-Based Cohort Study. Neurology 2022; 98:e711-e720. [PMID: 34996878 PMCID: PMC8865890 DOI: 10.1212/wnl.0000000000013205] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives Individuals with chronic kidney disease (CKD) appear to be at increased risk of cognitive impairment, with both vascular and neurodegenerative mechanisms postulated. To explore the vascular hypothesis, we studied the association between CKD and dementia before and after TIA and stroke. Methods In a prospective, population-based cohort study of TIA and stroke (Oxford Vascular Study; 2002–2012), pre-event and new postevent dementia were ascertained through direct patient assessment and follow-up for 5 years, supplemented by review of hospital/primary care records. Associations between pre-event dementia and CKD (defined as an estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) were examined using logistic regression and between postevent dementia and CKD using Cox and competing risk regression models, adjusted for age, sex, education, stroke severity, prior stroke, white matter disease, diabetes mellitus, and dysphasia. Results Among 2,305 patients with TIA/stroke (median [interquartile range] age, 77 [67–84] years, 1,133 [49%] male, 688 [30%] TIA), 1,174 (50.9%) had CKD. CKD was associated with both pre-event (odds ratio [OR] 2.04 [95% confidence interval (CI) 1.52–2.72]; p < 0.001) and postevent dementia (hazard ratio [HR] 2.01 [95% CI 1.65–2.44]; p < 0.001), but these associations attenuated after adjustment for covariates (OR 0.92 [0.65–1.31]; p = 0.65 and HR 1.09 [0.85–1.39]; p = 0.50). The results were similar when a competing risk model was used (subdistribution HR [SHR] 1.74 [1.43–2.12]; p < 0.001, attenuating to 1.01 [0.78–1.33]; p = 0.92 with adjustment). CKD was more strongly associated with late (>1 year) postevent dementia (SHR 2.32 [1.70–3.17]; p < 0.001), particularly after TIA and minor stroke (SHR 3.08 [2.05–4.64]; p < 0.001), but not significantly so after adjustment (SHR 1.53 [0.90–2.60]; p = 0.12). Discussion In patients with TIA and stroke, CKD was not independently associated with either pre- or postevent dementia, suggesting that renal-specific mechanisms are unlikely to play an important role in aetiology.
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Affiliation(s)
- Dearbhla M Kelly
- Wolfson Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom
| | - Sarah T Pendlebury
- Wolfson Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom
| | - Peter M Rothwell
- Wolfson Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom.
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Jalnapurkar S, Landes S, Wei J, Mehta PK, Shufelt C, Minissian M, Pepine CJ, Handberg E, Cook-Wiens G, Sopko G, Bairey Merz CN. Coronary endothelial dysfunction appears to be a manifestation of a systemic process: A report from the Women's Ischemia Syndrome Evaluation - Coronary Vascular Dysfunction (WISE-CVD) study. PLoS One 2021; 16:e0257184. [PMID: 34570768 PMCID: PMC8476029 DOI: 10.1371/journal.pone.0257184] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
Background Coronary microvascular dysfunction (CMD) is prevalent in symptomatic women with ischemia but no obstructive coronary artery disease (INOCA). Urine albumin-creatinine ratio (UACR) is a measure of renal microvascular endothelial dysfunction. Both are predictors of adverse cardiovascular events. It is unknown if CMD could be a manifestation of a systemic process. We evaluated the relationship between renal microvascular dysfunction and CMD as measured by invasive coronary function testing (CFT). Methods and results We measured urine albumin and creatinine to provide UACR in 152 women enrolled in the Women’s Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction (WISE-CVD) study (2008–2015) with suspected INOCA who underwent CFT. Invasive CFT measures of endothelial and non-endothelial dependent coronary microvascular function were obtained. Subjects were divided into those with detectable (≥20 mg/g) and undetectable urine albumin (<20 mg/g). The group mean age was 54 ± 11 years, with a moderate cardiac risk factor burden including low diabetes prevalence, and a mean UACR of 12 ± 55 mg/g (range 9.5–322.7 mg/g). Overall, coronary endothelial-dependent variables (change in coronary blood flow and coronary diameter in response to cold pressor testing) had significant inverse correlations with log UACR (r = -0.17, p = 0.05; r = -0.18, p = 0.03, respectively). Conclusions Among women with INOCA and relatively low risk factor including diabetes burden, renal microvascular dysfunction, measured by UACR, is related to coronary endothelial-dependent CMD. These results suggest that coronary endothelial-dependent function may be a manifestation of a systemic process. Enhancing efferent arteriolar vasodilatation in both coronary endothelial-dependent function and renal microvascular dysfunction pose potential targets for investigation and treatment. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT00832702.
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Grants
- R03 AG032631 NIA NIH HHS
- R01 HL146158 NHLBI NIH HHS
- U01 64829 NIA NIH HHS
- U54 AG065141 NIA NIH HHS
- N01 HV068164 NHLBI NIH HHS
- N01 HV068161 NHLBI NIH HHS
- R01 HL090957 NHLBI NIH HHS
- K23 HL127262 NHLBI NIH HHS
- K23 HL125941 NHLBI NIH HHS
- R01 HL124649 NHLBI NIH HHS
- U01 HL064914 NHLBI NIH HHS
- N01HV68162 NHLBI NIH HHS
- T32 HL069751 NHLBI NIH HHS
- M01 RR000425 NCRR NIH HHS
- N01HV68163 NHLBI NIH HHS
- K23 HL105787 NHLBI NIH HHS
- U01 HL064924 NHLBI NIH HHS
- K23 HL151867 NHLBI NIH HHS
- National Heart, Lung and Blood Institutes
- National Center for Research Resources
- National Center for Advancing Translational Sciences
- Gustavus and Louise Pfeiffer Research Foundation
- The Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, CA
- Ladies Hospital Aid Society
- QMED, Inc., Laurence Harbor, NJ
- Edythe L. Broad and the Constance Austin Women’s Heart Research Fellowships, Cedars-Sinai Medical Center, Los Angeles, California
- Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles
- The Society for Women’s Health Research (SWHR), Washington, D.C.
- Linda Joy Pollin Women’s Heart Health Program, the Erika Glazer Women’s Heart Health Project
- Adelson Family Foundation, Cedars-Sinai Medical Center, Los Angeles, California
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Affiliation(s)
- Sawan Jalnapurkar
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Sofy Landes
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Janet Wei
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Puja K. Mehta
- Emory Clinical Cardiovascular Research Institute (ECCRI), Emory University School of Medicine, Atlanta, GA, United States of America
| | - Chrisandra Shufelt
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Margo Minissian
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
| | - Eileen Handberg
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
| | - Galen Cook-Wiens
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - George Sopko
- Division of Cardiovascular Diseases, National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
- * E-mail:
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9
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Chronic Kidney Disease and Cognitive Impairment. J Stroke Cerebrovasc Dis 2021; 30:105529. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/05/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
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10
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Johansen KL, Garimella PS, Hicks CW, Kalra PA, Kelly DM, Martens S, Matsushita K, Sarafidis P, Sood MM, Herzog CA, Cheung M, Jadoul M, Winkelmayer WC, Reinecke H. Central and peripheral arterial diseases in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2021; 100:35-48. [PMID: 33961868 PMCID: PMC9833277 DOI: 10.1016/j.kint.2021.04.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 02/08/2023]
Abstract
Chronic kidney disease (CKD) affects about 10% of all populations worldwide, with about 2 million people requiring dialysis. Although patients with CKD are at high risk of cardiovascular disease and events, they are often underrepresented or excluded in clinical trials, leading to important knowledge gaps about how to treat these patients. KDIGO (Kidney Disease: Improving Global Outcomes) convened the fourth clinical Controversies Conference on the heart, kidney and vasculature in Dublin, Ireland, in February 2020, entitled Central and Peripheral Arterial Diseases in Chronic Kidney Disease. A global panel of multidisciplinary experts from the fields of nephrology, cardiology, neurology, surgery, radiology, vascular biology, epidemiology, and health economics attended. The objective was to identify key issues related to the optimal detection, management, and treatment of cerebrovascular diseases, central aortic disease, renovascular disease, and peripheral artery disease in the setting of CKD. This report outlines the common pathophysiology of these vascular processes in the setting of CKD, describes best practices for their diagnosis and management, summarizes areas of uncertainty, addresses ongoing controversial issues, and proposes a research agenda to address key gaps in knowledge that, when addressed, could improve patient care and outcomes.
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Affiliation(s)
- Kirsten L Johansen
- Division of Nephrology, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Division of Nephrology, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Pranav S Garimella
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK; Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Dearbhla M Kelly
- Wolfson Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Sven Martens
- Department of Cardiothoracic Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus, Münster, Germany
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Pantelis Sarafidis
- Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Charles A Herzog
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Division of Cardiology, Hennepin Healthcare, Minneapolis, Minnesota, USA; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes (KDIGO), Brussels, Belgium
| | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Holger Reinecke
- Department of Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany.
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11
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Kelly DM, Ademi Z, Doehner W, Lip GYH, Mark P, Toyoda K, Wong CX, Sarnak M, Cheung M, Herzog CA, Johansen KL, Reinecke H, Sood MM. Chronic Kidney Disease and Cerebrovascular Disease: Consensus and Guidance From a KDIGO Controversies Conference. Stroke 2021; 52:e328-e346. [PMID: 34078109 DOI: 10.1161/strokeaha.120.029680] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The global health burden of chronic kidney disease is rapidly rising, and chronic kidney disease is an important risk factor for cerebrovascular disease. Proposed underlying mechanisms for this relationship include shared traditional risk factors such as hypertension and diabetes, uremia-related nontraditional risk factors, such as oxidative stress and abnormal calcium-phosphorus metabolism, and dialysis-specific factors such as cerebral hypoperfusion and changes in cardiac structure. Chronic kidney disease frequently complicates routine stroke risk prediction, diagnosis, management, and prevention. It is also associated with worse stroke severity, outcomes and a high burden of silent cerebrovascular disease, and vascular cognitive impairment. Here, we present a summary of the epidemiology, pathophysiology, diagnosis, and treatment of cerebrovascular disease in chronic kidney disease from the Kidney Disease: Improving Global Outcomes Controversies Conference on central and peripheral arterial disease with a focus on knowledge gaps, areas of controversy, and priorities for research.
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Affiliation(s)
- Dearbhla M Kelly
- Wolfson Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom (D.M.K.)
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (Z.A.)
| | - Wolfram Doehner
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), and Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin and Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany (W.D.)
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom (G.Y.H.L.)
| | - Patrick Mark
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (P.M.)
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T.)
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia (C.X.W.)
| | - Mark Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, MA (M.S.)
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes, Brussels, Belgium (M.C.)
| | | | - Kirsten L Johansen
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN (K.L.J.)
| | - Holger Reinecke
- Department of Cardiology I, University Hospital Münster, Germany (H.R.)
| | - Manish M Sood
- Ottawa Hospital Research Institute, Department of Medicine, The Ottawa Hospital, Civic Campus, ON, Canada (M.M.S.)
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12
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YILMAZ DA, YILDIRIM MS, YILDIZ M, OKYAR G. CENTRAL NERVOUS SYSTEM RESPONSE TO CHRONIC KIDNEY DISEASE. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.917658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Due to the aging of the human population, the prevalence of chronic diseases such as chronic kidney disease (CKD) is increasing every year. Chronic kidney disease is a general term that refers to heterogeneous disorders that affect kidney structure and function. Decrease in glomerular filtration can be defined as chronic and progressive deterioration in fluid-solute balance, metabolic and endocrine functions of the kidney. CKD often affects the elderly. With the advancement of age, some structural and functional changes occur in the kidneys. Therefore, the number of patients suffering from mild and moderate CKD is expected to increase in the future.CKD leads to the deep metabolic and hemodynamic changes that damage other organs, such as the heart and brain. CNS abnormalities and cognitive deficits progress with the severity of CBS and occurs mostly among hemodialysis patients. It also has great socio-economic effects on individuals. Since symptoms of CKD are not often found in patients, early recognition of risk factors is the main point. For this reason, it is necessary to identify possible protective and preventive treatments to be applied in at-risk groups and to examine these mechanisms for the treatment of the disease. This review provides available information on the relevant mechanisms.
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Difference in risk factors of silent brain infarction between paroxysmal and persistent atrial fibrillation. IJC HEART & VASCULATURE 2021; 33:100753. [PMID: 33778153 PMCID: PMC7985474 DOI: 10.1016/j.ijcha.2021.100753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 01/28/2023]
Abstract
Differences in risk factors for SBI between paroxysmal and persistent AF was studied. NVAF patients (119 paroxysmal, 71 persistent) underwent brain MRI, TTE, and TEE. DM and CKD, which represents microvascular disease, predicted SBI in paroxysmal AF. There was no obvious therapeutic target for SBI after progression to persistent NVAF. Intervention for DM and CKD from paroxysmal NVAF may prevent SBI and future stroke.
Background Although silent brain infarction is an independent risk factor for subsequent symptomatic stroke and dementia in patients with nonvalvular atrial fibrillation, little is known regarding differences in risk factors for silent brain infarction between patients with paroxysmal and persistent nonvalvular atrial fibrillation. Methods This study population consisted of 190 neurologically asymptomatic patients (mean age, 64 ± 11 years) with nonvalvular atrial fibrillation (119 paroxysmal, 71 persistent) who were scheduled for catheter ablation. All patients underwent brain magnetic resonance imaging to screen for silent brain infarction prior to ablation. Transthoracic and transesophageal echocardiography was performed to screen for left atrial abnormalities (left atrial enlargement, spontaneous echo contrast, or left atrial appendage emptying velocity) and complex plaques in the aortic arch. Results Silent brain infarction was detected in 50 patients (26%) [26 patients (22%) in paroxysmal vs. 24 patients (34%) in persistent, p = 0.09]. Multiple logistic regression analysis indicated that age and diabetes mellitus or chronic kidney disease (estimated glomerular filtration rate < 60 mL/min/1.73 m2) were associated with silent brain infarction in patients with paroxysmal nonvalvular atrial fibrillation (p < 0.05), whereas no modifiable risk factors of silent brain infarction were observed in patients with persistent nonvalvular atrial fibrillation. Conclusions These findings suggest that intensive intervention for diabetes mellitus and renal impairment from the paroxysmal stage or ablation therapy at the time of paroxysmal stage to prevent progression to persistent nonvalvular atrial fibrillation may prevent silent brain infarction and consequently reduce the risk of future symptomatic stroke.
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14
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Lyerly MJ. Acute Stroke Care for Patients with Chronic Kidney Disease. J Stroke Cerebrovasc Dis 2021; 30:105725. [PMID: 33745804 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/20/2022] Open
Abstract
Chronic kidney disease is a common comorbidity in patients presenting to emergency departments with acute ischemic stroke. There are numerous considerations that must be taken into account in the acute diagnosis and management of these patients. CKD patients may have different stroke presentations compared to the general population that may make diagnosis more challenging. With the expanding use of endovascular thrombectomy for acute ischemic stroke, more contrasted studies are being employed as part of the acute evaluation, particularly in the identification of patients with large vessel occlusion and demonstration of salvageable penumbra. For most patients with renal dysfunction, studies such as CT angiography and perfusion may still be performed despite concerns of acute kidney injury. Although patient outcomes with reperfusion therapies such as intravenous alteplase and endovascular thrombectomy are not as robust as those seen within the general population, the available data supports utilization of these therapies among CKD patients. This article provides a review of the factors that must be considered in the acute management of the CKD patient presenting with acute ischemic stroke.
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Affiliation(s)
- Michael J Lyerly
- Department of Neurology, University of Alabama at Birmingham, 1813 6th Avenue South, RWUH M226, Birmingham, AL 35294, USA; Birmingham VA Medical Center, USA.
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15
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Detweiler MB, Lutgens BW, Choudhury D, Kenneth A, Kalafat N, Sherigar RM, Bader G. Association of Renal Clearance with Cerebral White Matter Vascular Disease in Hospitalized Veterans With and Without Delirium. South Med J 2021; 113:401-406. [PMID: 32747970 DOI: 10.14423/smj.0000000000001132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the relation between renal function and delirium and to assess and compare the relation between cerebral white matter lesion (WML) and renal function as estimated by three formulas for the estimated glomerular filtration rate (eGFR) in older adult hospitalized veterans with and without delirium. METHODS Commonly used formulas to assess renal function-the four-variable Modification of Diet in Renal Disease (MDRD), the six-variable MDRD, and the Cockcroft-Gault eGFR equations-were used to assess renal function in 100 older adult hospitalized veterans with delirium (delirium group) and 100 hospitalized veterans without delirium (nondelirium group) that were age, sex, and race matched. WML location and volumes were assessed using brain computed tomography imaging for each of the 200 veterans in the study. One radiologist, blinded to the diagnoses of the veterans, examined head computed tomography scans for WML in the cortex, subcortex (frontal, temporal, parietal, occipital lobes), basal ganglia (globus pallidus, caudate, putamen), and internal capsule. WML were graded as not present, <1 cm, 1 to 2 cm, or >2 cm. Exploratory χ2 analyses were used to determine the association between the stage of chronic kidney disease and WML. Simple logistic regression analyses were then used to estimate the strength of association between the stages of kidney disease and WML for particular regions of the brain. RESULTS The mean age of delirium group and nondelirium group veterans was 66 years. χ2 tests revealed no reliable relation between stages of renal disease and delirium. χ2 exploratory analyses of WML in brain regions by renal disease stages demonstrated significant differences in associations among the MDRD-4, MDRD-6, and Cockcroft-Gault formulas for measuring eGFR. The MDRD-4 formula was least associated with the presence or absence of WML. The Cockcroft-Gault estimation of eGFR was most associated with the presence or absence of WML. Simple logistic regressions showed notable increases in the association between stages of renal failure and WMLs in specific areas of the brain, with the MDRD-4 being the least associative with the fewest specific areas and the Cockcroft-Gault formula being the most associative with the most specific areas. CONCLUSIONS The association between stages 2 through 5 of chronic kidney disease and WLM support the role of kidney function as a potential risk factor for WML in older adult military veterans. The Cockcroft-Gault formula is an important renal index of suspected WML and renal stages 2 through 5, superior to the MDRD-6 and MDRD-4, respectively, in association with WML in older adult military veterans.
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Affiliation(s)
- Mark B Detweiler
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Brian W Lutgens
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Devasmita Choudhury
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Arline Kenneth
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Naciye Kalafat
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Rathnakara M Sherigar
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Geoffrey Bader
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
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16
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Michna M, Kovarova L, Valerianova A, Malikova H, Weichet J, Malik J. Review of the structural and functional brain changes associated with chronic kidney disease. Physiol Res 2020; 69:1013-1028. [PMID: 33129242 PMCID: PMC8549872 DOI: 10.33549/physiolres.934420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) leads to profound metabolic and hemodynamic changes, which damage other organs, such as heart and brain. The brain abnormalities and cognitive deficit progress with the severity of the CKD and are mostly expressed among hemodialysis patients. They have great socio-economic impact. In this review, we present the current knowledge of involved mechanisms.
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Affiliation(s)
- M Michna
- Department of Radiology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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17
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Kelly DM, Rothwell PM. Impact of multimorbidity on risk and outcome of stroke: Lessons from chronic kidney disease. Int J Stroke 2020; 16:758-770. [PMID: 33243088 PMCID: PMC8521355 DOI: 10.1177/1747493020975250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With both an aging population and greater post-stroke survival, multimorbidity is a growing healthcare challenge, affecting over 40% of stroke patients, and rising rapidly and predictably with increasing age. Commonly defined as the co-occurrence of two or more chronic conditions, multimorbidity burden is a strong adverse prognostic factor, associated with greater short- and long-term stroke mortality, worse rehabilitation outcomes, and reduced use of secondary prevention. Chronic kidney disease can be considered as the archetypal comorbidity, being age-dependent and also affecting about 40% of stroke patients. Chronic kidney disease and stroke share very similar traditional cardiovascular risk factor profiles such as hypertension and diabetes, though novel chronic kidney disease-specific risk factors such as inflammation and oxidative stress have also been proposed. Using chronic kidney disease as an exemplar condition, we explore the mechanisms of risk in multimorbidity, implications for management, impact on stroke severity, and downstream consequences such as post-stroke cognitive impairment and dementia.
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Affiliation(s)
- Dearbhla M Kelly
- Nuffield Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, John Radcliffe Hospital, University of Oxford, UK
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, John Radcliffe Hospital, University of Oxford, UK
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18
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Suchy-Dicey AM, Zhang Y, McPherson S, Tuttle KR, Howard BV, Umans J, Buchwald DS. Glomerular filtration function decline, mortality, and cardiovascular events: data from the Strong Heart Study. KIDNEY360 2020; 2:71-78. [PMID: 33954294 PMCID: PMC8096185 DOI: 10.34067/kid.0000782020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rapid kidney decline is associated with mortality and cardiovascular disease, even in the absence of chronic kidney disease. American Indians (AI) have particularly high burden of kidney disease, cardiovascular disease, and stroke. This study aims to examine extreme loss in glomerular function in this population in association with clinical outcomes. METHODS The Strong Heart Study, a large longitudinal cohort of adult AI participants, collected plasma creatinine at 3 examination visits between 1989-1999. Intraindividual regressions of estimated glomerular filtration rate (eGFR) provided linear estimates of change in kidney function over this time period. Surveillance with physician adjudication identified mortality and cardiovascular events between visit 3 through 2017. RESULTS Mean change in eGFR was loss 6.8 mL/min over the ten year baseline (range: -66.0 to +28.9 mL/min). The top 1 percentile lost approximately 5.7 mL/min/year. Participants with extreme eGFR loss were more likely to have diabetes (95% vs 71%), hypertension (49% vs 33%), or longer smoking history, among smokers (19 pack years vs 17 pack years). CKD (eGFR<60 mL/min) was associated only with mortality, independent of slope: HR 1.1 (95% CI 1.0-1.3). However, extreme loss in eGFR (>20 mL/min over baseline period) was associated with mortality, independent of baseline eGFR: HR 3.5 (95% CI 2.7-4.4), and also independently associated with composite CVD events and CHF: HR 1.4 and 1.7 (95% CI 1.1-1.9 and 1.2-2.6), respectively. CONCLUSION This is the first examination of decline in eGFR in association with mortality and CVD among AIs. The implications of these findings are broad: clinical evaluation may benefit from evaluating change in eGFR over time in addition to dichotomous eGFR. Also, these findings suggest there may be aspects of renal function that are not well-marked by clinical CKD, but which may have particular relevance to long-term renal and vascular health.
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Affiliation(s)
- Astrid M. Suchy-Dicey
- Elson S Floyd College of Medicine, Washington State University, Spokane, Washington,Institute for Research and Education to Advance Community Health, Seattle, Washington
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, Oklahoma University College of Public Health, Oklahoma City, Oklahoma
| | - Sterling McPherson
- Elson S Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Health Care, Spokane, Washington,Kidney Research Institute, Nephrology Division, University of Washington, Seattle, Washington
| | | | - Jason Umans
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Dedra S. Buchwald
- Elson S Floyd College of Medicine, Washington State University, Spokane, Washington,Institute for Research and Education to Advance Community Health, Seattle, Washington
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19
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Ito A, Iwata S, Tamura S, Kim AT, Nonin S, Ishikawa S, Ito A, Izumiya Y, Abe T, Shibata T, Yoshiyama M. Prevalence and Risk Factors of Silent Brain Infarction in Patients with Aortic Stenosis. Cerebrovasc Dis Extra 2020; 10:116-123. [PMID: 33032286 PMCID: PMC7588680 DOI: 10.1159/000510438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Silent brain infarction (SBI) is an independent risk factor for subsequent symptomatic stroke in the general population. Although aortic stenosis (AS) is also known to be associated with an increased risk of future symptomatic stroke, little is known regarding the prevalence and risk factors for SBI in patients with AS. Methods The study population comprised 83 patients with severe AS with no history of stroke or transient ischemic attack and paralysis or sensory impairment (mean age 75 ± 7 years). All patients underwent brain magnetic resonance imaging to screen for SBI and multidetector-row computed tomography to quantify the aortic valve calcification (AVC) volume. Comprehensive transthoracic and transesophageal echocardiography were performed to evaluate left atrial (LA) abnormalities, such as LA enlargement, spontaneous echo contrast, or abnormal LA appendage emptying velocity (<20 cm/s), and complex plaques in the aortic arch. Results SBI was detected in 38 patients (46%). Multiple logistic regression analysis indicated that CHA<sub>2</sub>DS<sub>2</sub>-VASc score and estimated glomerular filtration rate (eGFR) were independently associated with SBI (p < 0.05), whereas LA abnormalities and AVC volume were not. When patients were divided into 4 groups according to CHA<sub>2</sub>DS<sub>2</sub>-VASc score and eGFR, the group with a higher CHA<sub>2</sub>DS<sub>2</sub>-VASc score (≥4) and a lower eGFR (<60 mL/min/1.73 m<sup>2</sup>) had a greater risk of SBI than the other groups (p < 0.05). Conclusion These findings indicate that AS is associated with a high prevalence of SBI, and that the CHA<sub>2</sub>DS<sub>2</sub>-VASc score and eGFR are useful for risk stratification.
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Affiliation(s)
- Ayaka Ito
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Shinichi Iwata
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan,
| | - Soichiro Tamura
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Andrew T Kim
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Shinichi Nonin
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Sera Ishikawa
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Asahiro Ito
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Takato Abe
- Department of Neurology, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine Osaka, Osaka, Japan
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Miglinas M, Cesniene U, Janusaite MM, Vinikovas A. Cerebrovascular Disease and Cognition in Chronic Kidney Disease Patients. Front Cardiovasc Med 2020; 7:96. [PMID: 32582768 PMCID: PMC7283453 DOI: 10.3389/fcvm.2020.00096] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 05/06/2020] [Indexed: 12/16/2022] Open
Abstract
Chronic kidney disease (CKD) affects both brain structure and function. Patients with CKD have a higher risk of both ischemic and hemorrhagic strokes. Age, prior disease history, hypertension, diabetes, atrial fibrillation, smoking, diet, obesity, and sedimentary lifestyle are most common risk factors. Renal-specific pathophysiologic derangements, such as oxidative stress, chronic inflammation, endothelial dysfunction, vascular calcification, anemia, gut dysbiosis, and uremic toxins are important mediators. Dialysis initiation constitutes the highest stroke risk period. CKD significantly worsens stroke outcomes. It is essential to understand the risks and benefits of established stroke therapeutics in patients with CKD, especially in those on dialysis. Subclinical cerebrovascular disease, such as of silent brain infarction, white matter lesions, cerebral microbleeds, and cerebral atrophy are more prevalent with declining renal function. This may lead to functional brain damage manifesting as cognitive impairment. Cognitive dysfunction has been linked to poor compliance with medications, and is associated with greater morbidity and mortality. Thus, understanding the interaction between renal impairment and brain is important in to minimize the risk of neurologic injury in patients with CKD. This article reviews the link between chronic kidney disease and brain abnormalities associated with CKD in detail.
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Affiliation(s)
- Marius Miglinas
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ugne Cesniene
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Marta Monika Janusaite
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arturas Vinikovas
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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21
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Cheng BC, Chen PC, Chen PC, Lu CH, Huang YC, Chou KH, Li SH, Lin AN, Lin WC. Decreased cerebral blood flow and improved cognitive function in patients with end-stage renal disease after peritoneal dialysis: An arterial spin-labelling study. Eur Radiol 2019; 29:1415-1424. [PMID: 30105409 PMCID: PMC6510858 DOI: 10.1007/s00330-018-5675-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/06/2018] [Accepted: 07/17/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the relationship between cognitive impairment and brain perfusion using arterial spin labelling (ASL) in end-stage renal disease (ESRD) patients undergoing PD. METHODS ESRD patients undergoing PD were recruited. Laboratory screening, neuropsychological tests and ASL magnetic resonance imaging (MRI) were conducted prior to and after 6 months of PD. Age- and sex-matched normal subjects without ESRD served as the control group. Comparisons of regional CBF between ESRD patients before or after undergoing PD and normal controls were performed. Correlations between biochemical, neuropsychological and CBF data were also conducted to evaluate the relationships. RESULTS ESRD patients showed poor performance in many of the neuropsychological tests; PD improved cognition in some domains. Pre-PD patients had higher mean CBF than post-PD patients and normal controls, but no significant difference was found between the normal controls and post-PD patients. Negative correlations were observed pre-PD (regional CBF in left hippocampus vs. perseverative responses, r = -0.662, p = 0.014), post-PD (mean CBF vs. haemoglobin level, r = -0.766, p = 0.002), and before and after PD (change in CBF in the left putamen vs. change in haematocrit percentage, r = -0.808, p = 0.001). CONCLUSION Before PD, ESRD patients had increased cerebral perfusion that was related to poorer executive function, especially in the left hippocampus. Post-PD patients performed better in some cognitive test domains than pre-PD patients. The degree of anaemia, i.e., haemoglobin level or haematocrit percentage, might predict cognitive impairment in PD patients. KEY POINTS • In this study, ESRD patients before PD had cerebral hyperperfusion that was related to poorer executive function. • Post-PD patients performed better in some cognitive test domains than pre-PD patients did. • The degree of anaemia might predict cognitive impairment in PD patients.
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Affiliation(s)
- Ben-Chung Cheng
- Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Pei-Chin Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Kun-Hsien Chou
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Shau-Hsuan Li
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan.
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Hamed SA. Neurologic conditions and disorders of uremic syndrome of chronic kidney disease: presentations, causes, and treatment strategies. Expert Rev Clin Pharmacol 2019; 12:61-90. [PMID: 30501441 DOI: 10.1080/17512433.2019.1555468] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sherifa A. Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
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Kim SH, Shin DW, Yun JM, Lee JE, Lim JS, Cho BL, Kwon HM, Park JH. Kidney dysfunction and silent brain infarction in generally healthy adults. J Neurol Sci 2017; 379:89-93. [PMID: 28716287 DOI: 10.1016/j.jns.2017.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The association between silent brain infarction (SBI) and estimated glomerular filtration rate (eGFR)-based kidney dysfunction has not yet been definitively confirmed. This study aimed to investigate the association in generally healthy adults without a previous history of stroke or overt kidney disease. METHODS The data from the screening health check-up program in the Seoul National University Hospital Health Promotion Center from January 1, 2009 to December 31, 2013 were used. A total of 2594 subjects who underwent brain MRI as part of health screening were included. SBIs were identified using T2-weighted and FLAIR images. Kidney dysfunction was defined as eGFR<60ml/min/1.73m2. To assess the effect of kidney dysfunction on the small perforating branches of cerebral vessels, subgroup analysis was performed using the presence of SLI as a dependent variable. RESULTS The mean age was 56.8±9.3years, and 1422 subjects (54.8%) were male. The mean eGFR level was 81.9±15.4ml/min/1.73m2. The prevalence rates of kidney dysfunction and SBI were 5.1% and 7.1%, respectively. A higher proportion of subjects with SBI had kidney dysfunction than subjects without SBI (14.6% vs. 4.4%). The number of SBI lesions tended to increase with the progression of kidney dysfunction (p for trend<0.001). In multivariate logistic regression analyses, kidney dysfunction was significantly associated with the presence of SBI (adjusted odd ratio=1.99 to 2.21 in all four models). The same significant association was consistently identified in subgroup analyses using silent lacunar infarction (adjusted odd ratio=1.71 to 1.87 in all four models). CONCLUSION Kidney dysfunction was found to be an independent risk factor for the presence and number of SBI in generally healthy adults. Physicians treating patients with a decreased creatinine-based eGFR level should try to identify and modify the coexisting risk factors of stroke followed by SBI.
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Affiliation(s)
- Sang Hyuck Kim
- Health Screening and Promotion Center, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea; Department of Family Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Eun Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Be Long Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University-Seoul Municipal Government Boramae Medical Center, Seoul, Republic of Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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24
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Jabbari B, Vaziri ND. The nature, consequences, and management of neurological disorders in chronic kidney disease. Hemodial Int 2017; 22:150-160. [PMID: 28799704 DOI: 10.1111/hdi.12587] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Perhaps no other organ in the body is affected as often and in as many ways as the brain is in patients with chronic kidney disease (CKD). Several factors contribute to the neurological disorders in CKD including accumulation of uremic toxins, metabolic and hemodynamic disorders, oxidative stress, inflammation, and impaired blood brain barrier among others. The neurological disorders in CKD involve both peripheral and central nervous system. The peripheral neurological symptoms of CKD are due to somatic and cranial peripheral neuropathies as well as a myopathy. The central neurological symptoms of CKD are due to the cortical predominantly cortical, or subcortical lesions. Cognitive decline, encephalopathy, cortical myoclonus, asterixis and epileptic seizures are distinct features of the cortical disorders of CKD. Diffuse white matter disease due to ischemia and hypoxia may be an important cause of subcortical encephalopathy. A special and more benign form of subcortical disorder caused by brain edema in CKD is termed posterior reversible encephalopathy. Subcortical pathology especially when it affects the basal ganglia causes a number of movement disorders including Parkinsonism, chorea and dystonia. A stimulus-sensitive reflex myoclonus is believed to originate from the medullary structures. Sleep disorder and restless leg syndrome are common in CKD and have both central and peripheral origin. This article provides an overview of the available data on the nature, prevalence, pathophysiology, consequences and treatment of neurological complications of CKD.
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Affiliation(s)
- Bahman Jabbari
- Department of Neurology, Division of Movement disorders, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nosratola D Vaziri
- Departments of Medicine, Physiology and Biophysics, Division of Nephrology and Hypertension, University of California, Irvine, USA
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25
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Chen CH, Chen YF, Chiu MJ, Chen TF, Tsai PH, Chen JH, Yen CJ, Tang SC, Yeh SJ, Chen YC. Effect of Kidney Dysfunction on Cerebral Cortical Thinning in Elderly Population. Sci Rep 2017; 7:2337. [PMID: 28539636 PMCID: PMC5443828 DOI: 10.1038/s41598-017-02537-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/12/2017] [Indexed: 11/18/2022] Open
Abstract
Chronic kidney disease has been linked to cognitive impairment and morphological brain change. However, less is known about the impact of kidney functions on cerebral cortical thickness. This study investigated the relationship between kidney functions and global or lobar cerebral cortical thickness (CTh) in 259 non-demented elderly persons. Forty-three participants (16.7%) had kidney dysfunction, which was defined as either a glomerular filtration rate (GFR) of <60 ml/min/1.73 m2 or presence of proteinuria. Kidney dysfunction was associated with lower global (β = −0.05, 95% CI = −0.08 to −0.01) as well as frontal, parietal, temporal, occipital, and insular lobar CTh. In the stratified analysis, the associations were more pronounced in women, APOEε4 non-carriers, and participants with a lower cognitive score. Besides, kidney dysfunction significantly increased the risk of cortical thinning, defined as being the lowest CTh tertile, in the insular lobe (adjusted odds ratio = 2.74, 95% CI = 1.31−5.74). Our results suggested that kidney dysfunction should be closely monitored and managed in elderly population to prevent neurodegeneration.
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Affiliation(s)
- Chih-Hao Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, 10055, Taiwan.,Department of Neurology, National Taiwan University Hospital, No. 1, Changde Street, Taipei, 10048, Taiwan.,Division of Neurology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Nanya South Road, Banciao District, New Taipei City, 22060, Taiwan
| | - Ya-Fang Chen
- Department of Medical Imaging, National Taiwan University Hospital, No. 1, Changde Street, Taipei, 10048, Taiwan
| | - Ming-Jang Chiu
- Department of Neurology, National Taiwan University Hospital, No. 1, Changde Street, Taipei, 10048, Taiwan
| | - Ta-Fu Chen
- Department of Neurology, National Taiwan University Hospital, No. 1, Changde Street, Taipei, 10048, Taiwan
| | - Ping-Huan Tsai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, 10055, Taiwan
| | - Jen-Hau Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, 10055, Taiwan.,Department of Geriatrics and Gerontology, National Taiwan University Hospital, No. 1, Changde Street, Taipei, 10048, Taiwan
| | - Chung-Jen Yen
- Department of Internal Medicine, National Taiwan University Hospital, No. 1, Changde Street, Taipei, 10048, Taiwan
| | - Sung-Chun Tang
- Department of Neurology, National Taiwan University Hospital, No. 1, Changde Street, Taipei, 10048, Taiwan
| | - Shin-Joe Yeh
- Department of Neurology, National Taiwan University Hospital, No. 1, Changde Street, Taipei, 10048, Taiwan
| | - Yen-Ching Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, 10055, Taiwan. .,Department of Public Health, National Taiwan University, No. 17 Xu-Zhou Road, Taipei, 10055, Taiwan. .,Research Center for Genes, Environment and Human Health, College of Public Health, National Taiwan University, No. 17 Xu-Zhou Road, Taipei, 10055, Taiwan.
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26
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Cognitive Impairment in Chronic Kidney Disease: Vascular Milieu and the Potential Therapeutic Role of Exercise. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2726369. [PMID: 28503567 PMCID: PMC5414492 DOI: 10.1155/2017/2726369] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 02/28/2017] [Indexed: 02/08/2023]
Abstract
Chronic kidney disease (CKD) is considered a model of accelerated aging. More specifically, CKD leads to reduced physical functioning and increased frailty, increased vascular dysfunction, vascular calcification and arterial stiffness, high levels of systemic inflammation, and oxidative stress, as well as increased cognitive impairment. Increasing evidence suggests that the cognitive impairment associated with CKD may be related to cerebral small vessel disease and overall impairment in white matter integrity. The triad of poor physical function, vascular dysfunction, and cognitive impairment places patients living with CKD at an increased risk for loss of independence, poor health-related quality of life, morbidity, and mortality. The purpose of this review is to discuss the available evidence of cerebrovascular-renal axis and its interconnection with early and accelerated cognitive impairment in patients with CKD and the plausible role of exercise as a therapeutic modality. Understanding the cerebrovascular-renal axis pathophysiological link and its interconnection with physical function is important for clinicians in order to minimize the risk of loss of independence and improve quality of life in patients with CKD.
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27
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Shen Z, Ruan Q, Yu Z, Sun Z. Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review. Geriatr Gerontol Int 2017; 17:529-544. [PMID: 27240548 DOI: 10.1111/ggi.12758] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/12/2016] [Indexed: 11/28/2022]
Abstract
AIM The objective of this review was to assess chronic kidney disease-related frailty and cognitive impairment, as well as their probable causes, mechanisms and the interventions. METHODS Studies from 1990 to 2015 were reviewed to evaluate the relationship between chronic kidney disease and physical frailty and cognitive impairment. Of the 1694 studies from the initial search, longitudinal studies (n = 22) with the keywords "Cognitive and CKD" and longitudinal or cross-sectional studies (n = 5) with the keywords "Frailty and CKD" were included in final analysis. RESULTS By pooling current research, we show clear evidence for a relationship between chronic kidney disease and frailty and cognitive impairment in major studies. Vascular disease is likely an important mediator, particularly for cognitive impairment. However, non-vascular factors also play an important role. Many of the other mechanisms that contribute to impaired cognitive function and increased frailty in CKD remain to be elucidated. In limited studies, medication therapy did not obtain the ideal effect. There are limited data on treatment strategies, but addressing the vascular disease risk factors earlier in life might decrease the subsequent burden of frailty and cognitive impairment in this population. Multidimensional interventions, which address both microvascular health and other factors, may have substantial benefits for both the cognitive impairments and physical frailty in this vulnerable population. CONCLUSIONS Chronic kidney disease is a potential cause of frailty and cognitive impairment. Vascular and non-vascular factors are the possible causes. The mechanism of chronic kidney disease-induced physical frailty and cognitive impairment suggests that multidimensional interventions may be effective therapeutic strategies in the early stage of chronic kidney disease. Geriatr Gerontol Int 2017; 17: 529-544.
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Affiliation(s)
- Zhiyuan Shen
- Department of Urology, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, China
| | - Qingwei Ruan
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhuowei Yu
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhongquan Sun
- Department of Urology, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, China
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28
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Hayashi K, Takayama M, Kanda T, Kashiwagi K, Hishikawa A, Iwao Y, Itoh H. Association of Kidney Dysfunction With Asymptomatic Cerebrovascular Abnormalities in a Japanese Population With Health Checkups. Circ J 2017; 81:1191-1197. [DOI: 10.1253/circj.cj-17-0140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kaori Hayashi
- Center for Preventive Medicine, Keio University Hospital
- Department of Internal Medicine, School of Medicine, Keio University
| | | | - Takeshi Kanda
- Department of Internal Medicine, School of Medicine, Keio University
| | | | - Akihito Hishikawa
- Department of Internal Medicine, School of Medicine, Keio University
| | - Yasushi Iwao
- Center for Preventive Medicine, Keio University Hospital
| | - Hiroshi Itoh
- Department of Internal Medicine, School of Medicine, Keio University
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29
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Jeon JW, Jeong HS, Choi DE, Ham YR, Na KR, Lee KW, Shin JW, Kim J. Prognostic Relationships between Microbleed, Lacunar Infarction, White Matter Lesion, and Renal Dysfunction in Acute Ischemic Stroke Survivors. J Stroke Cerebrovasc Dis 2016; 26:385-392. [PMID: 27793532 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/09/2016] [Accepted: 09/22/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND It is well known that renal dysfunction and cerebral small-vessel disease (SVD), including microbleed, lacunar infarction, and white matter lesion (WML), are associated with poor prognosis after ischemic stroke. However, the prognostic relationship between renal dysfunction and SVD has not been well evaluated in acute ischemic stroke survivors. Therefore, in this study, we evaluated the prognostic relationships between estimated glomerular filtration rate (eGFR) and cerebral SVD after acute ischemic stroke. METHODS We retrospectively reviewed the clinical and radiological data of acute ischemic stroke survivors with decreased eGFR (<60 mL/min/1.73 m2, n = 128) and controls (eGFR ≥60 mL/min/1.73 m2, n = 128). The presence of SVD was evaluated according to magnetic resonance imaging performed on admission. Mortality data were obtained from medical chart reviews and telephone interviews. RESULTS Patients with silent lacunar infarction, WML, or microbleed had lower eGFR than patients without such lesions (60.4 ± 34.8 versus 87.5 ± 28.4 mL/min/1.73 m2, 60.5 ± 37.1 versus 73.9 ± 33.3 mL/min/1.73 m2, and 57.6 ± 33.3 versus 73.9 ± 32.9 mL/min/1.73 m2, respectively). In addition, the multivariate adjusted odds ratio for the presence of SVD increased inversely with eGFR. Three-year survival was lower in patients with renal dysfunction and each type of SVD. The presence of WML was an independent risk factor for cardiovascular death. CONCLUSIONS Renal impairment was associated with the presence of SVD in acute ischemic stroke survivors. Both renal impairment and the presence of SVD were predictors of poor poststroke survival.
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Affiliation(s)
- Jae Woong Jeon
- Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hye Seon Jeong
- Department of Neurology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
| | - Dae Eun Choi
- Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
| | - Young Rok Ham
- Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ki Ryang Na
- Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kang Wook Lee
- Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong Wook Shin
- Department of Neurology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jei Kim
- Department of Neurology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
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30
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Shima H, Mori T, Ooi M, Sonoda M, Shoji T, Ishimura E, Okamura M, Ishizaka N, Inaba M. Silent Cerebral Microbleeds and Longitudinal Risk of Renal and Cardiovascular Events in Patients with CKD. Clin J Am Soc Nephrol 2016; 11:1557-1565. [PMID: 27354659 PMCID: PMC5012493 DOI: 10.2215/cjn.13481215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 05/06/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In the general population, the presence of cerebral microbleeds on T2*-weighted magnetic resonance imaging has been reported to be a predictor of future stroke. Patients with CKD have a high prevalence of microbleeds and are at higher risk of ESRD as well as cardiovascular disease, including stroke. Because endothelial dysfunction is the common pathophysiology among microbleeds, CKD, and cardiovascular disease, we hypothesized that the presence of microbleeds would be an important predictor of composite outcome, including both cardiovascular disease and renal events, in those with CKD. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS This was a prospective cohort study of 404 patients with CKD who underwent T2*-weighted magnetic resonance imaging for this study between January of 2008 and January of 2011. The primary outcome was composite of cardiovascular and renal outcomes. Cardiovascular outcomes included cardiovascular death, the new onset of myocardial infarction, coronary revascularization, stroke, and amputation/revascularization because of peripheral artery disease. Renal outcomes included doubling of the serum creatinine level and development of ESRD requiring dialysis or transplantation. RESULTS At baseline, microbleeds were present in 83 (20.5%) patients. During the follow-up median period of 2.3 years, 124 of the 404 patients experienced the composite outcome. The presence of microbleeds was associated with higher risk for the composite outcome in an unadjusted Cox model, and it remained significant after adjustment for age, sex, diabetes, and systolic BP (hazard ratio [HR], 2.58; 95% confidence interval [95% CI], 1.68 to 3.46 for composite outcome; hazard ratio, 2.41; 95% CI, 1.55 to 3.77 for renal outcome; hazard ratio, 3.46; 95% CI, 1.62 to 7.43 for cardiovascular disease outcome). CONCLUSIONS In patients with CKD, the presence of microbleeds is a novel and independent predictor of both renal and cardiovascular disease end points.
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Affiliation(s)
- Hideaki Shima
- Division of Nephrology, Department of Internal Medicine and
| | - Tatsuhiko Mori
- Division of Nephrology, Department of Internal Medicine and
| | - Masayuki Ooi
- Division of Nephrology, Department of Internal Medicine and
| | - Mika Sonoda
- Departments of Endocrinology, Metabolism and Molecular Medicine
| | | | - Eiji Ishimura
- Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan; and
| | - Mikio Okamura
- Division of Nephrology, Ohno Memorial Hospital, Osaka, Japan
| | - Nobukazu Ishizaka
- Division of Cardiology, Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Masaaki Inaba
- Departments of Endocrinology, Metabolism and Molecular Medicine
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31
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Liu Y, Lv P, Jin H, Cui W, Niu C, Zhao M, Fan C, Teng Y, Pan B, Peng Q, Luo J, Zheng L, Huang Y. Association between Low Estimated Glomerular Filtration Rate and Risk of Cerebral Small-Vessel Diseases: A Meta-Analysis. J Stroke Cerebrovasc Dis 2016; 25:710-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/03/2015] [Accepted: 11/07/2015] [Indexed: 11/27/2022] Open
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Tasmoc A, Donciu MD, Veisa G, Nistor I, Covic A. Increased arterial stiffness predicts cognitive impairment in hemodialysis patients. Hemodial Int 2016; 20:463-72. [DOI: 10.1111/hdi.12406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/27/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Alexandra Tasmoc
- Dialysis and Renal Transplantation Center; “Dr. C. I. Parhon” University Hospital; Iasi Romania
- Faculty of Medicine, Medical Deontology and Bioethics Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
- Faculty of Medicine, Nephrology Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
| | - Mihaela-Dora Donciu
- Faculty of Medicine, Nephrology Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
| | - Gabriel Veisa
- Faculty of Medicine, Nephrology Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
| | - Ionut Nistor
- Faculty of Medicine, Nephrology Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
| | - Adrian Covic
- Faculty of Medicine, Nephrology Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
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Mohandas R, Segal MS, Huo T, Handberg EM, Petersen JW, Johnson BD, Sopko G, Bairey Merz CN, Pepine CJ. Renal function and coronary microvascular dysfunction in women with symptoms/signs of ischemia. PLoS One 2015; 10:e0125374. [PMID: 25951606 PMCID: PMC4423851 DOI: 10.1371/journal.pone.0125374] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/23/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Chronic kidney disease (CKD) is more prevalent among women and is associated with adverse cardiovascular events. Among women with symptoms and signs of ischemia enrolled in the Women's Ischemia Syndrome Evaluation (WISE), a relatively high mortality rate was observed in those with no obstructive coronary artery disease. Coronary microvascular dysfunction or reduced coronary flow reserve (CFR) was a strong and independent predictor of adverse outcomes. The objective of this analysis was to determine if renal function was associated with coronary microvascular dysfunction in women with signs and symptoms of ischemia. METHODS The WISE was a multicenter, prospective, cohort study of women undergoing coronary angiography for suspected ischemia. Among 198 women with additional measurements of CFR, we determined the estimated glomerular filtration rate (eGFR) with the CKD-EPI equation. We tested the association between eGFR and CFR with regression analysis. RESULTS The median eGFR was 89 ml/min. The eGFR correlated with CFR (r = 0.22; P = 0.002). This association persisted even after covariate adjustment. Each 10-unit decrease in eGFR was associated with a 0.04-unit decrease in CFR (P = 0.04).There was a strong interaction between eGFR and age (P = 0.006): in those ≥60 years old, GFR was strongly correlated with CFR (r = 0.55; P<0.0001). No significant correlation was noted in those <60 years old. CONCLUSIONS Reduced renal function was significantly associated with lower CFR in women with symptoms and signs of ischemia. Coronary microvascular dysfunction warrants additional study as a mechanism contributing to increased risk of cardiovascular events in CKD.
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Affiliation(s)
- Rajesh Mohandas
- Nephrology and Hypertension Section, North Florida/South Georgia Veterans Health System, Gainesville, Florida, United States of America
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, United States of America
| | - Mark S. Segal
- Nephrology and Hypertension Section, North Florida/South Georgia Veterans Health System, Gainesville, Florida, United States of America
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, United States of America
| | - Tianyao Huo
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Eileen M. Handberg
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, United States of America
| | - John W. Petersen
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, United States of America
| | - B. Delia Johnson
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - George Sopko
- National Institutes of Health, Bethesda, Maryland, United States of America
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, United States of America
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Reetz K, Abbas Z, Costa AS, Gras V, Tiffin-Richards F, Mirzazade S, Holschbach B, Frank RD, Vassiliadou A, Krüger T, Eitner F, Gross T, Schulz JB, Floege J, Shah NJ. Increased cerebral water content in hemodialysis patients. PLoS One 2015; 10:e0122188. [PMID: 25826269 PMCID: PMC4380497 DOI: 10.1371/journal.pone.0122188] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 02/10/2015] [Indexed: 12/27/2022] Open
Abstract
Little information is available on the impact of hemodialysis on cerebral water homeostasis and its distribution in chronic kidney disease. We used a neuropsychological test battery, structural magnetic resonance imaging (MRI) and a novel technique for quantitative measurement of localized water content using 3T MRI to investigate ten hemodialysis patients (HD) on a dialysis-free day and after hemodialysis (2.4±2.2 hours), and a matched healthy control group with the same time interval. Neuropsychological testing revealed mainly attentional and executive cognitive dysfunction in HD. Voxel-based-morphometry showed only marginal alterations in the right inferior medial temporal lobe white matter in HD compared to controls. Marked increases in global brain water content were found in the white matter, specifically in parietal areas, in HD patients compared to controls. Although the global water content in the gray matter did not differ between the two groups, regional increases of brain water content in particular in parieto-temporal gray matter areas were observed in HD patients. No relevant brain hydration changes were revealed before and after hemodialysis. Whereas longer duration of dialysis vintage was associated with increased water content in parieto-temporal-occipital regions, lower intradialytic weight changes were negatively correlated with brain water content in these areas in HD patients. Worse cognitive performance on an attention task correlated with increased hydration in frontal white matter. In conclusion, long-term HD is associated with altered brain tissue water homeostasis mainly in parietal white matter regions, whereas the attentional domain in the cognitive dysfunction profile in HD could be linked to increased frontal white matter water content.
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Affiliation(s)
- Kathrin Reetz
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Institute of Neuroscience and Medicine (INM-4), Research Centre Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
- * E-mail:
| | - Zaheer Abbas
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Institute of Neuroscience and Medicine (INM-4), Research Centre Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
| | - Ana Sofia Costa
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
| | - Vincent Gras
- Institute of Neuroscience and Medicine (INM-4), Research Centre Jülich GmbH, Jülich, Germany
| | - Frances Tiffin-Richards
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
| | - Shahram Mirzazade
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Institute of Neuroscience and Medicine (INM-4), Research Centre Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
| | - Bernhard Holschbach
- KfH Kuratorium für Dialyse und Nierentransplantation e.V., Stolberg, Germany
| | - Rolf Dario Frank
- Department of Internal Medicine, St.-Antonius-Hospital Eschweiler, Eschweiler, Germany
| | | | - Thilo Krüger
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Frank Eitner
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Theresa Gross
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Jörg Bernhard Schulz
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Nadim Jon Shah
- Department of Neurology, RWTH Aachen University Hospital, Germany
- Institute of Neuroscience and Medicine (INM-4), Research Centre Jülich GmbH, Jülich, Germany
- Jülich Aachen Research Alliance (JARA)—Translational Brain Medicine, Jülich and Aachen, Germany
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Toyoda G, Bokura H, Mitaki S, Onoda K, Oguro H, Nagai A, Yamaguchi S. Association of mild kidney dysfunction with silent brain lesions in neurologically normal subjects. Cerebrovasc Dis Extra 2015; 5:22-7. [PMID: 25873927 PMCID: PMC4376920 DOI: 10.1159/000373916] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 01/07/2015] [Indexed: 11/25/2022] Open
Abstract
Background Chronic kidney disease (CKD) has been closely associated with stroke. Although a large number of studies reported the relationship between CKD and different types of asymptomatic brain lesions, few comprehensive analyses have been performed for all types of silent brain lesions. Methods We performed a cross-sectional study involving 1,937 neurologically normal subjects (mean age 59.4 years). Mild CKD was defined as an estimated glomerular filtration rate between 30 and 60 ml/min/1.73 m2 or positive proteinuria. Results The prevalence of mild CKD was 8.7%. Univariate analysis revealed an association between CKD and all silent brain lesions, including silent brain infarction, periventricular hyperintensity, subcortical white matter lesion, and microbleeds, in addition to hypertension and diabetes mellitus after adjusting for age and sex. In binary logistic regression analysis, the presence of CKD was a significant risk factor for all types of silent brain lesions, independent of other risk factors. Conclusions These results suggest that mild CKD is independently associated with all types of silent brain lesions, even in neurologically normal subjects.
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Affiliation(s)
- Genya Toyoda
- Department of Neurology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Hirokazu Bokura
- Department of Neurology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shingo Mitaki
- Department of Neurology, Shimane University, Izumo, Japan
| | - Keiichi Onoda
- Department of Neurology, Shimane University, Izumo, Japan
| | - Hiroaki Oguro
- Department of Neurology, Shimane University, Izumo, Japan
| | - Atsushi Nagai
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, Izumo, Japan
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Bansal VK, Bansal S. Nervous system disorders in dialysis patients. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:395-404. [DOI: 10.1016/b978-0-7020-4086-3.00025-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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38
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Murakami M, Suzuki JI, Yamazaki S, Ikezoe M, Matsushima R, Ashigaki N, Aoyama N, Kobayashi N, Wakayama K, Akazawa H, Komuro I, Izumi Y, Isobe M. High incidence of Aggregatibacter actinomycetemcomitans infection in patients with cerebral infarction and diabetic renal failure: a cross-sectional study. BMC Infect Dis 2013; 13:557. [PMID: 24267704 PMCID: PMC4222637 DOI: 10.1186/1471-2334-13-557] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent epidemiological studies suggest that periodontitis is a major risk factor for renal failure and cerebral infarction. The aim of this study was to evaluate the association among periodontitis, renal failure, and cerebral infarction, focusing on microbiological and immunological features. METHODS Twenty-one patients treated with hemodialysis (HD) were enrolled in this study. They were 8 with diabetic nephropathy and 13 with non-diabetic nephropathy. Blood examination, periodontal examination, brain magnetic resonance image (MRI), and dental radiography were performed on all patients. Subgingival plaque, saliva, and blood samples were analyzed for the periodontal pathogens, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), and Prevotella intermedia (P. intermedia) using quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA). RESULTS We found that the patients with diabetic nephropathy had more A. actinomycetemcomitans compared with non-diabetic nephropathy (P = 0.038) in dental plaque. Furthermore, the patients with diabetic nephropathy showed a significantly higher incidence of cerebral infarction compared with those with non-diabetic nephropathy (P = 0.029). Clinical oral and radiographic scores tended to be higher among patients in the diabetic nephropathy group than in the non-diabetic nephropathy group. CONCLUSIONS Periodontal pathogens, particularly A. actinomycetemcomitans, may play a role, at least a part, in the development of cerebral infarction in Japanese HD patients with diabetic nephropathy.
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Affiliation(s)
- Minoru Murakami
- Department of Advanced Clinical Science and Therapeutics, University of Tokyo, Tokyo, Japan.
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Moodalbail DG, Reiser KA, Detre JA, Schultz RT, Herrington JD, Davatzikos C, Doshi JJ, Erus G, Liu HS, Radcliffe J, Furth SL, Hooper SR. Systematic review of structural and functional neuroimaging findings in children and adults with CKD. Clin J Am Soc Nephrol 2013; 8:1429-48. [PMID: 23723341 DOI: 10.2215/cjn.11601112] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
CKD has been linked with cognitive deficits and affective disorders in multiple studies. Analysis of structural and functional neuroimaging in adults and children with kidney disease may provide additional important insights into the pathobiology of this relationship. This paper comprehensively reviews neuroimaging studies in both children and adults. Major databases (PsychLit, MEDLINE, WorldCat, ArticleFirst, PubMed, Ovid MEDLINE) were searched using consistent search terms, and studies published between 1975 and 2012 were included if their samples focused on CKD as the primary disease process. Exclusion criteria included case reports, chapters, and review articles. This systematic process yielded 43 studies for inclusion (30 in adults, 13 in children). Findings from this review identified several clear trends: (1) presence of cerebral atrophy and cerebral density changes in patients with CKD; (2) cerebral vascular disease, including deep white matter hyperintensities, white matter lesions, cerebral microbleeds, silent cerebral infarction, and cortical infarction, in patients with CKD; and (3) similarities in regional cerebral blood flow between patients with CKD and those with affective disorders. These findings document the importance of neuroimaging procedures in understanding the effect of CKD on brain structure, function, and associated behaviors. Results provide a developmental linkage between childhood and adulthood, with respect to the effect of CKD on brain functioning across the lifespan, with strong implications for a cerebrovascular mechanism contributing to this developmental linkage. Use of neuroimaging methods to corroborate manifest neuropsychological deficits or perhaps to indicate preventive actions may prove useful to individuals with CKD.
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Affiliation(s)
- Divya G Moodalbail
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Rajagopalan P, Refsum H, Hua X, Toga AW, Jack CR, Weiner MW, Thompson PM. Mapping creatinine- and cystatin C-related white matter brain deficits in the elderly. Neurobiol Aging 2013; 34:1221-30. [PMID: 23182131 PMCID: PMC3603573 DOI: 10.1016/j.neurobiolaging.2012.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/09/2012] [Accepted: 10/23/2012] [Indexed: 11/19/2022]
Abstract
Poor kidney function is associated with increased risk of cognitive decline and generalized brain atrophy. Chronic kidney disease impairs glomerular filtration rate, and this deterioration is indicated by elevated blood levels of kidney biomarkers such as creatinine and cystatin C. Here we hypothesized that impaired renal function would be associated with brain deficits in regions vulnerable to neurodegeneration. Using tensor-based morphometry, we related patterns of brain volumetric differences to creatinine, cystatin C levels, and glomerular filtration rate in a large cohort of 738 (mean age, 75.5 ± 6.8 years; 438 men, 300 women) elderly Caucasian subjects scanned as part of the Alzheimer's Disease Neuroimaging Initiative. Elevated kidney biomarkers were associated with volume deficits in the white matter region of the brain. All 3 renal parameters in our study showed significant associations consistently with a region that corresponds with the anterior limb of internal capsule, bilaterally. This is the first study to report a marked profile of structural alterations in the brain associated with elevated kidney biomarkers, helping us to explain the cognitive deficits.
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Affiliation(s)
- Priya Rajagopalan
- Imaging Genetics Center, Laboratory of Neuro Imaging, Department of Neurology, UCLA, Los Angeles, CA, USA
| | - Helga Refsum
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Xue Hua
- Imaging Genetics Center, Laboratory of Neuro Imaging, Department of Neurology, UCLA, Los Angeles, CA, USA
| | - Arthur W. Toga
- Imaging Genetics Center, Laboratory of Neuro Imaging, Department of Neurology, UCLA, Los Angeles, CA, USA
| | | | - Michael W. Weiner
- Departments of Radiology, Medicine, and Psychiatry, UCSF, San Francisco, CA, USA
- Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Paul M. Thompson
- Imaging Genetics Center, Laboratory of Neuro Imaging, Department of Neurology, UCLA, Los Angeles, CA, USA
- Department of Psychiatry, Semel Institute, UCLA School of Medicine, Los Angeles, CA, USA
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Bugnicourt JM, Godefroy O, Chillon JM, Choukroun G, Massy ZA. Cognitive disorders and dementia in CKD: the neglected kidney-brain axis. J Am Soc Nephrol 2013; 24:353-63. [PMID: 23291474 DOI: 10.1681/asn.2012050536] [Citation(s) in RCA: 401] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Epidemiologic data suggest that individuals at all stages of CKD have a higher risk of developing cognitive disorders and dementia. This risk is generally explained by the high prevalence of both symptomatic and subclinical ischemic cerebrovascular lesions. However, other potential mechanisms, including direct neuronal injury by uremic toxins, could also be involved, especially in the absence of obvious cerebrovascular disease. We discuss the prevalence and characteristics of cognitive disorders and dementia in patients with CKD, brain imaging findings, and traditional and nontraditional risk factors. Understanding the pathophysiologic interactions between renal impairment and brain function is important in order to minimize the risk for future cognitive impairment.
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Affiliation(s)
- Jean-Marc Bugnicourt
- Service de Neurologie, CHU Amiens, Place Victor Pauchet F-80054, Amiens Cedex 1, France.
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Dorenkamp M, Bonaventura K, Leber AW, Boldt J, Sohns C, Boldt LH, Haverkamp W, Frei U, Roser M. Potential lifetime cost-effectiveness of catheter-based renal sympathetic denervation in patients with resistant hypertension. Eur Heart J 2012; 34:451-61. [PMID: 23091202 DOI: 10.1093/eurheartj/ehs355] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS Recent studies have demonstrated the safety and efficacy of catheter-based renal sympathetic denervation (RDN) for the treatment of resistant hypertension. We aimed to determine the cost-effectiveness of this approach separately for men and women of different ages. METHODS AND RESULTS A Markov state-transition model accounting for costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness was developed to compare RDN with best medical therapy (BMT) in patients with resistant hypertension. The model ran from age 30 to 100 years or death, with a cycle length of 1 year. The efficacy of RDN was modelled as a reduction in the risk of hypertension-related disease events and death. Analyses were conducted from a payer's perspective. Costs and QALYs were discounted at 3% annually. Both deterministic and probabilistic sensitivity analyses were performed. When compared with BMT, RDN gained 0.98 QALYs in men and 0.88 QALYs in women 60 years of age at an additional cost of €2589 and €2044, respectively. As the incremental cost-effectiveness ratios increased with patient age, RDN consistently yielded more QALYs at lower costs in lower age groups. Considering a willingness-to-pay threshold of €35 000/QALY, there was a 95% probability that RDN would remain cost-effective up to an age of 78 and 76 years in men and women, respectively. Cost-effectiveness was influenced mostly by the magnitude of effect of RDN on systolic blood pressure, the rate of RDN non-responders, and the procedure costs of RDN. CONCLUSION Renal sympathetic denervation is a cost-effective intervention for patients with resistant hypertension. Earlier treatment produces better cost-effectiveness ratios.
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Affiliation(s)
- Marc Dorenkamp
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Pathophysiological Mechanisms of Carotid Plaque Vulnerability: Impact on Ischemic Stroke. Arch Immunol Ther Exp (Warsz) 2012; 60:431-42. [DOI: 10.1007/s00005-012-0192-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
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Kovács KR, Czuriga D, Bereczki D, Bornstein NM, Csiba L. Silent Brain Infarction – A Review of Recent Observations. Int J Stroke 2012; 8:334-47. [DOI: 10.1111/j.1747-4949.2012.00851.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Silent brain infarction is a cerebral ischaemic event evident on brain imaging without any clinical symptom. Silent brain infarction is often detected in apparently healthy, elderly people and in different selected patient groups as well. Lately, several studies were carried out in order to identify the clinical conditions leading to silent brain infarction. A large number of clinical and paraclinical parameters were found to increase silent brain infarction prevalence, and the continuously growing list of risk factors revealed that the majority of them are similar to those related to stroke. Accordingly, some consider silent brain infarction the preclinical stage of clinically overt stroke. This point of view emphasizes the early recognition and management of silent brain infarction-related risk factors, and a great need for comparative studies, which could elicit the most sensitive indicators of the increased silent brain infarction risk, especially the ones that could be cost-effectively screened in the large populations as well.
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Affiliation(s)
- Katalin Réka Kovács
- Department of Neurology, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | - Dániel Czuriga
- Institute of Cardiology, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Natan M. Bornstein
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - László Csiba
- Department of Neurology, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
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Clinical Features and Neurologic Severity in Stroke Patients with Mild to Moderate Renal Dysfunction. J Stroke Cerebrovasc Dis 2012; 21:343-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 08/20/2010] [Accepted: 08/25/2010] [Indexed: 11/24/2022] Open
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Vogels SC, Emmelot-Vonk MH, Verhaar HJ, Koek H(DL. The association of chronic kidney disease with brain lesions on MRI or CT: A systematic review. Maturitas 2012; 71:331-6. [DOI: 10.1016/j.maturitas.2012.01.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 01/13/2012] [Accepted: 01/13/2012] [Indexed: 10/14/2022]
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Kuriyama N, Mizuno T, Ohshima Y, Yamada K, Ozaki E, Shigeta M, Mitani S, Kondo M, Matsumoto S, Takeda K, Nakagawa M, Watanabe Y. Intracranial deep white matter lesions (DWLs) are associated with chronic kidney disease (CKD) and cognitive impairment: a 5-year follow-up magnetic resonance imaging (MRI) study. Arch Gerontol Geriatr 2011; 56:55-60. [PMID: 22177547 DOI: 10.1016/j.archger.2011.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 11/16/2011] [Accepted: 11/20/2011] [Indexed: 10/14/2022]
Abstract
Stroke incidence and cognitive decline are related to progression of arteriosclerosis in intracranial DWLs. However, the relationships between DWLs and factors associated with their progression, including CKD, have not been fully elucidated using longitudinal MRI. Of 291 individuals (184 males, 107 females; age 66.9 ± 6.1 years) who had voluntarily participated in a hospital-based health check-up and underwent repeated brain MRI scans in 2003 and 2008, 273 were evaluated in this study. The DWL group included those having DWL without progression, and the DWL progression (DWLP) group included those having an increase in grade number according to the Fazekas classification. Unimpaired age-matched subjects with no brain MRI abnormalities constituted Group C. The Mini-Mental State Examination (MMSE) and verbal fluency tasks were used for objective cognitive evaluations according to the MR evaluation schedule in 2008. Associations between DWLs and vascular risk factors were examined. DWLP occurred in 9.2% of subjects. Compared to Group C subjects, DWL and DWLP group subjects had high odds ratios (ORs) for hypertension (HT) (2.23 and 2.92, respectively) and CKD (1.40 and 2.41, respectively). After adjustment for potential confounders, the ORs of CKD for DWLs remained significant (1.13 and 1.43, p<0.05). DWLs and DWLP were associated with low cognitive scale scores and increased CKD. In conclusion, CKD was associated with DWLs and DWLP as an independent risk factor and a lower level of cognitive function 5 years after CKD was identified. Successful CKD therapy may be expected to prevent DWLP.
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Affiliation(s)
- N Kuriyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Pelisek J, Hahntow IN, Eckstein HH, Ockert S, Reeps C, Heider P, Luppa PB, Frank H. Impact of chronic kidney disease on carotid plaque vulnerability. J Vasc Surg 2011; 54:1643-9. [PMID: 21764239 DOI: 10.1016/j.jvs.2011.05.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/13/2011] [Accepted: 05/17/2011] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Little is known about the effect of chronic kidney disease (CKD) on plaque morphology in cerebral vessels. We therefore analyzed plaque composition and metabolic and chemical parameters with regard to clinical outcome in patients with advanced carotid artery stenosis (>70%) and normal or impaired renal function. METHODS Carotid endarterectomy plaques were collected from 114 patients, 51 with CKD and 63 without CKD (mean estimated glomerular filtration rate, 49 ± 9 vs 88 ± 14 mL/min), and analyzed by histology and immunohistochemistry. Serum levels of matrix metalloproteinases (MMP-1, -2, -3, -7, -8, and -9), calcium, phosphate, parathyroid hormone, fetuin-A, osteoprotegerin, and inflammatory factors, including fibrinogen, and high-sensitive C-reactive protein (hsCRP) were measured by appropriate enzyme-linked immunosorbent assay. RESULTS Compared with patients without CKD, patients with CKD had significantly more early-stage (11.2% vs 2.8%, P = .002) and end-stage (7.4% vs 0.2%, P = .036) calcification, unstable (50.8% vs 20.4%, P = .001) and ruptured (53.1% vs 32.8%, P = .035) lesions, and a significantly lower amount of collagenous fibers (39.2% vs 54.6%, P = .001). Serum samples of CKD patients had significantly enhanced levels of fibrinogen (393 ± 88 vs 331 ± 60 mg/dL, P = .018), hsCRP (1.7 ± 2.9 vs 0.8 ± 0.9 mg/dL; P = .042), parathyroid hormone (47.3 ± 24.1 vs 32.8 ± 12.2 ng/L, P = .010), fetuin-A (0.21 ± 0.05 vs 0.18 ± 0.04 mg/mL, P = .039), and MMP-7 (13.0 ± 5.3 vs 8.3 ± 3.0 ng/mL; P < 0.001). The incidence of cerebrovascular events >6 months before carotid surgery was significantly increased in CKD patients (84.0% vs 26.2% P < .001). CONCLUSIONS In patients with CKD and advanced carotid artery stenosis, morphologic changes in plaque composition may contribute to plaque vulnerability and consequently to the risk of cerebrovascular events. Furthermore, relevant serum markers of inflammation, vascular calcification, and vessel wall degradation might be an indication of stroke risk in CKD patients.
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Affiliation(s)
- Jaroslav Pelisek
- Clinic for Vascular Surgery, Klinikum rechts der Isar and German Heart Centre Munich, Technische Universität München, München, Germany.
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Losito A, Pittavini L, Ferri C, De Angelis L. Reduced kidney function and outcome in acute ischaemic stroke: relationship to arterial hypertension and diabetes. Nephrol Dial Transplant 2011; 27:1054-8. [DOI: 10.1093/ndt/gfr378] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Shima H, Ishimura E, Naganuma T, Ichii M, Yamasaki T, Mori K, Nakatani T, Inaba M. Decreased Kidney Function Is a Significant Factor Associated with Silent Cerebral Infarction and Periventricular Hyperintensities. Kidney Blood Press Res 2011; 34:430-8. [DOI: 10.1159/000328722] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 04/13/2011] [Indexed: 02/02/2023] Open
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