1
|
Han SL, Ou YN, Han BL, Guo HH, Chi HC, Huang YM, Wang HF, Tan L. Total Tau Protein Mediates the Association of Ischemic Cerebrovascular Disease with Cognitive Decline. J Alzheimers Dis 2024; 98:1133-1143. [PMID: 38578896 DOI: 10.3233/jad-231093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
Background Patients with transient ischemic attack (TIA) or ischemic stroke demonstrate an increased risk of cognitive dysfunction. Accumulating evidence indicates that ischemic cerebrovascular disease (ICVD) may interact with the amyloid/tau/neurodegeneration (AT[N]) biomarkers to promote dementia. However, the precise pathological mechanisms remain to be fully characterized. Objective To elucidate the interrelationships among ICVD, ATN biomarkers in cerebrospinal fluid (CSF), and cognition. Methods A total of 2524 participants were recruited from the CABLE study. ICVD referred to TIA/ischemic stroke. Cognitive performance was assessed by China Modified Mini-Mental State Examination (CM-MMSE) and Montreal Cognitive Assessment-b (MoCA-b). Multivariate linear regression analyses were performed to evaluate the associations of ICVD with CSF ATN biomarkers and cognition. Causal mediation analyses were used to identify whether the association was mediated by ATN biomarkers. Results ICVD was associated with higher total-tau (t-tau) (p = 2.828×10-2) and poorer cognition (CM-MMSE: p = 1.539×10-5, MoCA-b: p = 4.552×10-6). Additionally, no discernible correlation surfaced between ICVD and amyloid-β (Aβ) 42 (p = 6.910×10-1) or phosphorylated tau (p-tau) (p = 4.324×10-1). The influence of ICVD on cognitive function was partially mediated by CSF t-tau (CM-MMSE: proportion: 2.74%, MoCA-b: proportion: 2.51%). Subgroup analyses revealed the influences of t-tau were especially evident in male (CM-MMSE: proportion: 5.45%, MoCA-b: proportion: 5.38%) and mid-life group (CM-MMSE: proportion: 9.83%, MoCA-b: proportion: 5.31%). Conclusions These results delineated t-tau as a potential mediator for the influence of ICVD on cognition. Targeting brain ischemia and alleviating neuronal injury induced by ischemia may be a promising approach for preventing cognitive decline.
Collapse
Affiliation(s)
- Shuang-Ling Han
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Bao-Lin Han
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Hai-Hua Guo
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Hao-Chen Chi
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yi-Ming Huang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Hui-Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Department of Neurology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Department of Neurology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| |
Collapse
|
2
|
Rajesh K, Spring KJ, Beran RG, Bhaskar SMM. Chronic kidney disease prevalence and clinical outcomes in anterior circulation acute ischemic stroke patients with reperfusion therapy: A meta-analysis. Nephrology (Carlton) 2024; 29:21-33. [PMID: 37964507 DOI: 10.1111/nep.14251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/27/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
AIM Chronic Kidney Disease (CKD) is a common comorbidity among acute ischaemic stroke (AIS) patients undergoing reperfusion therapies, including intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). Acknowledging CKD's prevalence in this cohort and understanding its influence on outcomes is crucial for prognosis and optimizing care. This study aims to determine the prevalence of CKD among anterior circulation AIS (acAIS) patients undergoing reperfusion therapies and to analyse the role of CKD in mediating outcomes. METHODS A random-effects meta-analysis was conducted to pool and examine prevalence data. A total of 263 633 patients were included in the meta-analysis. The study assessed CKD's association with functional outcomes, symptomatic intracranial haemorrhage (sICH) and mortality. RESULTS The overall pooled prevalence of CKD among acAIS ranged from 30% to 56% in IVT-treated patients and 16%-42% for EVT-treated patients. CKD was associated with increased odds of unfavourable functional outcome at 90 days in both IVT (OR 1.837; 95% CI: [1.599; 2.110]; p < .001) and EVT (OR 1.804; 95% CI: [1.525; 2.133]; p < .001) groups. In IVT-treated patients, CKD was associated with increased odds of 30-day mortality (OR 6.211; 95% CI: [1.105; 34.909]; p = .038). CKD in IVT-treated patients exhibited increased odds of sICH, albeit statistically non-significant (OR 1.595; 95% CI: [0.567; 3.275]). CONCLUSIONS The high prevalence of CKD and its significant impact on outcomes in acAIS patients treated with reperfusion therapies underscore its clinical significance. This insight can guide personalised care strategies and potentially improve the prognosis in the management of acAIS.
Collapse
Affiliation(s)
- Kruthajn Rajesh
- Global Health Neurology Lab, Sydney, New South Wales, Australia
- UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, New South Wales, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, New South Wales, Australia
| | - Kevin J Spring
- UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, New South Wales, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Medical Oncology Group, Liverpool Clinical School, Ingham Institute for Applied Medical Research and Western Sydney University (WSU), Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Roy G Beran
- Global Health Neurology Lab, Sydney, New South Wales, Australia
- UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, New South Wales, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Griffith Health, School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, New South Wales, Australia
| | - Sonu M M Bhaskar
- Global Health Neurology Lab, Sydney, New South Wales, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, New South Wales, Australia
- Department of Neurology, National Cerebral and Cardiovascular Centre (NCVC), Suita, Osaka, Japan
| |
Collapse
|
3
|
Lan X, Ao WL, Li J. Molecular mechanism of Shengyang Yiwei Decoction in treating chronic kidney disease based on network pharmacology. Am J Transl Res 2023; 15:6878-6887. [PMID: 38186988 PMCID: PMC10767527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024]
Abstract
There is a serious worldwide health problem caused by chronic kidney disease (CKD), yet there are few viable therapies. Therapeutic promise in the treatment of chronic kidney disease (CKD) has been shown by the use of the traditional Chinese herbal compound Shengyang Yiwei Decoction (SYD). However, the chemical processes through which SYD exerts its effects are still unknown. The purpose of this network pharmacology research is to better understand the molecular mechanism of action of Shengyang Yiwei Decoction (SYD) in the treatment of chronic kidney disease (CKD). Traditional Chinese Medicine Systems Pharmacology (TCMSP) was first searched for information on the chemical components of Shengyang Yiwei Decoction. The molecular targets of SYD were then predicted using the Pharm Mapper service. After that, we used databases like DIG-SEE, TTD, and OMIM to zero down on the targets most closely linked to CKD. Cytoscape 3.2.1 was used to generate the component-target network representing SYD's therapy of CKD. In addition, KEGG signal pathways and GO biological processes were analyzed using the DAVID database, and the findings were displayed via OmicShare Tools. Twenty-two active components were isolated from Shengyang Yiwei Decoction, and they were linked to 36 therapeutic targets for CKD in the current investigation. According to the results of the network pharmacology study, 41 signaling pathways are involved in mediating the therapeutic effects of SYD. In addition, SYD's broad therapeutic impact in CKD therapy was shown to include 29 molecular activities, 14 cell components, and 91 biological processes. This research utilizes a multivariate analysis to provide light on the strategies and outcomes of treating CKD using Shengyang Yiwei Decoction. Clinical therapeutic methods for CKD management may benefit greatly from a thorough knowledge of the underlying processes and material foundation of this disease.
Collapse
Affiliation(s)
- Xinpeng Lan
- College of Basic Medical Sciences, Heilongjiang University of Chinese MedicineHarbin 150036, Heilongjiang, China
| | - Wu Liji Ao
- College of Mongolian Medicine and Pharmacy, Inner Mongolia University for NationalitiesTongliao 028000, Inner Mongolia, China
| | - Ji Li
- College of Basic Medical Sciences, Heilongjiang University of Chinese MedicineHarbin 150036, Heilongjiang, China
| |
Collapse
|
4
|
Zhang C, Xue G, Hou Y, Meng P, Gao H, Bai B, Li D. Association between kidney measurements and cognitive performance in patients with ischemic stroke. PLoS One 2023; 18:e0292506. [PMID: 38096197 PMCID: PMC10721055 DOI: 10.1371/journal.pone.0292506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Individuals with chronic kidney disease (CKD) are at a substantially higher risk for stroke, which may predispose individuals to cognitive impairment. However, the association of low estimated glomerular filtration rate (eGFR) and albuminuria with poorer cognitive performance in patients with stroke is not fully understood, and the current evidence for this association is contradictory. Our aim was to retrospectively investigate whether low eGFR and albuminuria, as indicated by the urine albumin-creatinine ratio (UACR), are independently or jointly associated with worse cognitive performance in patients with ischemic stroke. METHODS This retrospective study included 608 patients with acute ischemic stroke. Their UACR and eGFR values were obtained from inpatient medical records. Global cognitive function was assessed with the mini-mental state exam (MMSE) and Montreal Cognitive Assessment (MoCA) one month after hospital discharge. The relationship between renal measures and cognitive performance was assessed using univariate and multiple linear regression analyses. Potential confounders included age, gender, BMI, education, diabetes and hypertension history, NIHSS score, smoking and alcohol consumption status, serum total cholesterol, triglyceride, fasting glucose, uric acid, homocysteine, systolic blood pressure, and either eGFR or UACR. RESULTS Patients had an average age of 66.6±4.1 years, and 48% were females. Average eGFR and UACR were 88.4±12.9 ml/min/1.73m2 and 83.6±314.2 mg/g, respectively. The number of patients with eGFR ≥90, 60-89, and <60 ml/min/1.73 m2 was 371 (61%), 207 (34%), and 30 (5%), respectively, and the percentage of patients with UACR <30 mg/g, 30-300 mg/g, and >300 mg/g was 56%, 39%, and 5%, respectively. Multivariate adjusted models showed that eGFR was independently associated with MMSE (β = -0.4; 95% CI = -0.5,-0.4; p <0.001) and MoCA (β = -0.6; 95% CI = -0.7,-0.5; p <0.001). However, UACR was not significantly correlated with MMSE or MoCA. CONCLUSION In patients with ischemic stroke, reduced eGFR but not albuminuria was associated with lower cognitive performance. These results show that the eGFR decline could be an effective indicator of cognitive impairment after a stroke. Therefore, regular monitoring and early detection of mild renal dysfunction in patients with acute ischemic stroke might be needed.
Collapse
Affiliation(s)
- Chunyan Zhang
- Department of Neurology, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Guofang Xue
- Department of Neurology, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yanjuan Hou
- Department of Nephrology, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Pengfei Meng
- Department of Neurology, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Huizhong Gao
- Department of Neurology, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Bo Bai
- Department of Neurology, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Dongfang Li
- Department of Neurology, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| |
Collapse
|
5
|
Wang J, Xu X, Wang C, Ye D, Chen R, Peng P, Huang H, Yan Y, Chen Y, Wang S, Chen L, Gong H. Association of acute kidney injury with the risk of cognitive impairment or dementia: a systematic review and meta-analysis. Ren Fail 2023; 45:2279647. [PMID: 37964563 PMCID: PMC10653765 DOI: 10.1080/0886022x.2023.2279647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
PURPOSE Since previous studies have shown a paradoxical relationship between acute kidney injury (AKI) and risk of cognitive impairment, there is an urgent need for a meta-analysis to assess the relationship between AKI and risk of cognitive impairment or dementia. MATERIALS AND METHODS From database inception to October 2023, we searched PubMed, OVID (Medline), Embase, Web of Science, and Cochrane Library. This study examined AKI and cognitive impairment or dementia observational studies. Two authors independently assessed cohort and cross-sectional study quality using the Newcastle-Ottawa Scale and AHRQ Scale. They also used ROBINS-I to assess bias. The meta-analysis used fixed effects. Sensitivity analysis verified results stability. The funnel plot, Egger test, and Begg test determined publication bias in the results. RESULTS Seven studies with 423,876 patients were included in the meta-analysis. Patients with AKI were at higher risk of cognitive impairment or dementia compared to those who had not experienced AKI (OR = 1.87, 95% confidence interval [CI]: 1.77-1.98, I2=46.0%, p = 0.08). All subgroups showed a substantial connection between AKI and cognitive impairment. Compared to domestic research, the connection was stronger in overseas studies (OR = 2.18, 95% CI: 1.66-2.87). Both cognitive impairment and dementia outcomes showed a substantial connection between AKI and cognitive impairment, with OR values of 2.00 (95% CI: 1.44-2.76) and 2.04 (95% CI: 1.66-2.51). CONCLUSIONS We found that AKI significantly increases cognitive impairment or dementia risk. Thus, early interventions to delay cognitive impairment and prevent adverse outcomes in AKI patients are needed.
Collapse
Affiliation(s)
- Jiang Wang
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji’an, Jiangxi Province, China
- Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Jiangxi Province, China
| | - Xiao Xu
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji’an, Jiangxi Province, China
- Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Jiangxi Province, China
| | - Chunyan Wang
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji’an, Jiangxi Province, China
- Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Jiangxi Province, China
| | - Dongmei Ye
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji’an, Jiangxi Province, China
- Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Jiangxi Province, China
| | - Ruzhao Chen
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji’an, Jiangxi Province, China
- Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Jiangxi Province, China
| | - Pai Peng
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji’an, Jiangxi Province, China
- Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Jiangxi Province, China
| | - Huadong Huang
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji’an, Jiangxi Province, China
- Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Jiangxi Province, China
| | - Yuxiang Yan
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji’an, Jiangxi Province, China
- Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Jiangxi Province, China
| | - Ying Chen
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji’an, Jiangxi Province, China
- Department of Medicine, Jinggangshan University, Ji’an, Jiangxi Province, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Jiangxi Province, China
| | - Shixuan Wang
- Department of Philosophy, University of Jena, China
| | - Lan Chen
- Department of Neurology, Affiliated Hospital of Jinggangshan University, Jinggangshan University, Ji’an, Jiangxi Province, China
| | - Huping Gong
- College of Nursing, Gannan Medical University, Ganzhou, China
| |
Collapse
|
6
|
Xiao Y, Devakumar V, Xu L, Liu L, Mo H, Hong X. Elevated serum creatinine levels and risk of cognitive impairment in older adults with diabetes: a NHANES study from 2011-2014. Front Endocrinol (Lausanne) 2023; 14:1149084. [PMID: 37900140 PMCID: PMC10603184 DOI: 10.3389/fendo.2023.1149084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/17/2023] [Indexed: 10/31/2023] Open
Abstract
Background The brain and kidney have similar microvascular structure, which makes them susceptible to certain common pathophysiological processes. In this study, we examined several indicators of kidney injury/function associated with cognitive function in older diabetic patients in the hope of finding effective markers for detecting cognitive impairment (CI). Methods A total of 2209 older participants (aged ≥60 years) from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) were analyzed for the association between diabetes and CI using a multiple linear regression analysis model. Using the same approach, we also analyzed the relationship between indicators of kidney injury/function and cognitive function (Animal Fluency Test, Digit Symbol Substitution Test) in the diabetic population. Results Diabetes was associated with CI. In age-adjusted model, older diabetics performed significantly poorer on tests of cognitive function compared to normoglycaemic individuals (1.145 points lower on the Animal Fluency Test (P = 0.005) and 7.868 points reduced on the Digit Symbol Substitution Test (P < 0.001)). In diabetics, we found elevated serum creatinine (SCr) (especially at SCr≥300uM) was associated with lower scores on cognitive function tests after strict adjustment for potential influences on cognitive function. While, albumin/creatinine ratio (ACR) was only associated with Digit Symbol Substitution score (DSS) not Animal Fluency score (AFS), and estimated glomerular filtration rate (eGFR) was only associated with CI (AFS and DSS) at the end-stage renal disease. Conclusion SCr, as a sensitive indicator of kidney injury, was significantly associated with CI and can potentially be used as an effective marker for screening CI in older diabetics.
Collapse
Affiliation(s)
- Yanhua Xiao
- Department of Rheumatology and Immunology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Veda Devakumar
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Liyan Xu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Lei Liu
- Department of Rheumatology and Immunology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Hanyou Mo
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xuezhi Hong
- Department of Rheumatology and Immunology, Affiliated Hospital of Guilin Medical University, Guilin, China
| |
Collapse
|
7
|
Bobot M, Suissa L, Hak JF, Burtey S, Guillet B, Hache G. Kidney disease and stroke: epidemiology and potential mechanisms of susceptibility. Nephrol Dial Transplant 2023; 38:1940-1951. [PMID: 36754366 DOI: 10.1093/ndt/gfad029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Indexed: 02/10/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have an increased risk of both ischaemic and haemorrhagic stroke compared with the general population. Both acute and chronic kidney impairment are independently associated with poor outcome after the onset of a stroke, after adjustment for confounders. End-stage kidney disease (ESKD) is associated with a 7- and 9-fold increased incidence of both ischaemic and haemorrhagic strokes, respectively, poorer neurological outcome and a 3-fold higher mortality. Acute kidney injury (AKI) occurs in 12% of patients with stroke and is associated with a 4-fold increased mortality and unfavourable functional outcome. CKD patients seem to have less access to revascularisation techniques like thrombolysis and thrombectomy despite their poorer prognosis. Even if CKD patients could benefit from these specific treatments in acute ischaemic stroke, their prognosis remains poor. After thrombolysis, CKD is associated with a 40% increased risk of intracerebral haemorrhage (ICH), a 20% increase in mortality and poorer functional neurological outcomes. After thrombectomy, CKD is not associated with ICH but is still associated with increased mortality, and AKI with unfavourable outcome and mortality. The beneficial impact of gliflozins on the prevention of stroke is still uncertain. Non-traditional risk factors of stroke, like uraemic toxins, can lead to chronic cerebrovascular disease predisposing to stroke in CKD, notably through an increase in the blood-brain barrier permeability and impaired coagulation and thrombosis mechanisms. Preclinical and clinical studies are needed to specifically assess the impact of these non-traditional risk factors on stroke incidence and outcomes, aiming to optimize and identify potential therapeutic targets.
Collapse
Affiliation(s)
- Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
| | - Laurent Suissa
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- Unité Neurovasculaire/Stroke Center, Hôpital de la Timone, AP-HM, Marseille, France
| | - Jean-François Hak
- CERIMED, Aix Marseille Université, Marseille, France
- Service de Radiologie, Hôpital de la Timone, AP-HM, Marseille, France
| | - Stéphane Burtey
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
| | - Benjamin Guillet
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
- Service de Radiopharmacie, AP-HM, Marseille, France
| | - Guillaume Hache
- Aix-Marseille Université, INSERM 1263, INRAE 1260, C2VN, Marseille, France
- CERIMED, Aix Marseille Université, Marseille, France
- Pharmacie, Hôpital de la Timone, AP-HM, Marseille, France
| |
Collapse
|
8
|
Jong GP, Lin TK, Huang JY, Liao PL, Yang TY, Pan LF. Risk of New-Onset Dementia in Patients with Chronic Kidney Disease on Statin Users: A Population-Based Cohort Study. Biomedicines 2023; 11:biomedicines11041073. [PMID: 37189690 DOI: 10.3390/biomedicines11041073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/06/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Patients with chronic kidney disease (CKD) are at a higher risk for developing dementia than the general population. Clinical studies have investigated the effects of statin use on new-onset dementia (NOD) in patients with CKD; however, the findings are inconsistent. This study examines the association between the use of statins and NOD in patients with CKD. We conducted a nationwide retrospective cohort study using the Taiwan Health Insurance Review and Assessment Service database (2003–2016). The primary outcome assessed the risk of incident dementia by estimating the hazard ratios and 95% confidence intervals. Therefore, multiple Cox regression models were conducted to analyse the association between statin use and NOD in patients with CKD. There were 24,090 participants with statin use and 28,049 participants without statin use in patients with new-diagnosed CKD; the NOD event was 1390 and 1608, respectively. There was a trend of reduction association between statin users and NOD events after adjusted sex, age, comorbidities, and concurrent medication (adjusted HR 0.93, 95% CI 0.87 to 1.00) in the 14 years of the follow-up. Sensitivity test for the propensity score 1:1 matched analyses showed similar results (adjusted HR 0.91, 95% CI 0.81 to 1.02). The subgroup analysis also identified the use of statins as having a trend against developing NOD in patients with hypertension. In conclusion, statin therapy may effectively reduce the risk of NOD in patients with CKD. More studies are needed to credibly evaluate the effects of statin therapy on the prevention of NOD in patients with CKD.
Collapse
Affiliation(s)
- Gwo-Ping Jong
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Tsung-Kun Lin
- School of Pharmacy, National Defense Medical Center, Taipei 114201, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Pei-Lun Liao
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Tsung-Yuan Yang
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Lung-Fa Pan
- Department of Cardiology, Taichung Armed Forces General Hospital, Taichung 41168, Taiwan
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406053, Taiwan
| |
Collapse
|
9
|
Stefanou MI, Palaiodimou L, Theodorou A, Christodoulou MV, Tzartos JS, Tzanetakos D, Kitsos D, Chondrogianni M, Zouvelou V, Dardiotis E, Tzavellas E, Syrigou E, Benetou V, Paraskevas GP, Tsiodras S, Tsivgoulis G, Giannopoulos S. Safety of COVID-19 vaccines in multiple sclerosis: A systematic review and meta-analysis. Mult Scler 2023; 29:585-594. [PMID: 36722184 PMCID: PMC9895285 DOI: 10.1177/13524585221150881] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Data are sparse regarding the safety of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in patients with multiple sclerosis (MS). OBJECTIVE To estimate (1) the pooled proportion of MS patients experiencing relapse among vaccine recipients; (2) the rate of transient neurological worsening, adverse events, and serious adverse events; (3) the previous outcomes of interest for different SARS-CoV-2 vaccine types. METHODS Systematic review and meta-analysis of pharmacovigilance registries and observational studies. RESULTS Nineteen observational studies comprising 14,755 MS patients who received 23,088 doses of COVID-19 vaccines were included. Mean age was 43.3 years (95% confidence interval (CI): 40-46.6); relapsing-remitting, secondary-progressive, primary-progressive MS and clinically isolated syndrome were diagnosed in 82.6% (95% CI: 73.9-89.8), 12.6% (95% CI: 6.3-20.8), 6.7% (95% CI: 4.2-9.9), and 2.9% (95% CI: 1-5.9) of cases, respectively. The pooled proportion of MS patients experiencing relapse at a mean time interval of 20 days (95% CI: 12-28.2) from vaccination was 1.9% (95% CI: 1.3%-2.6%; I2 = 78%), with the relapse risk being independent of the type of administered SARS-CoV-2-vaccine (p for subgroup differences = 0.7 for messenger RNA (mRNA), inactivated virus, and adenovector-based vaccines). After vaccination, transient neurological worsening was observed in 4.8% (95% CI: 2.3%-8.1%) of patients. Adverse events and serious adverse events were reported in 52.8% (95% CI: 46.7%-58.8%) and 0.1% (95% CI: 0%-0.2%) of vaccinations, respectively. CONCLUSION COVID-19 vaccination does not appear to increase the risk of relapse and serious adverse events in MS. Weighted against the risks of SARS-CoV-2-related complications and MS exacerbations, these safety data provide compelling pro-vaccination arguments for MS patients.
Collapse
Affiliation(s)
| | | | - Aikaterini Theodorou
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Maria Veatriki Christodoulou
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - John S Tzartos
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Dimitrios Tzanetakos
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Dimitrios Kitsos
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Maria Chondrogianni
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Vasiliki Zouvelou
- First Department of Neurology, Eginition
Hospital, School of Medicine, National and Kapodistrian University of
Athens, Athens, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital
of Larissa, School of Health Sciences, Faculty of Medicine, University of
Thessaly, Larissa, Greece
| | - Elias Tzavellas
- First Department of Psychiatry, Aiginition
Hospital, School of Medicine, National and Kapodistrian University of
Athens, Athens, Greece
| | | | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and
Medical Statistics, National and Kapodistrian University of Athens, Athens,
Greece
| | - George P Paraskevas
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine,
Attikon University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | | | - Sotirios Giannopoulos
- S Giannopoulos Second Department of
Neurology, “Attikon” University Hospital, School of Medicine, National and
Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece.
| |
Collapse
|
10
|
Zhang C, Yu H, Cai Y, Wu N, Liang S, Zhang C, Duan Z, Zhang Z, Cai G. Diffusion tensor imaging of the brain white matter microstructure in patients with chronic kidney disease and its correlation with cognition. Front Neurol 2022; 13:1086772. [PMID: 36588888 PMCID: PMC9798235 DOI: 10.3389/fneur.2022.1086772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose In individuals with chronic kidney disease (CKD), neurological damage is commonly observed. This neurodegeneration is closely linked to microstructural damage to the brain white matter due to the high incidence of cognitive dysfunction. However, the specific pathogenesis of CKD nephropathy caused by cognitive system developmental disorders remains unclear. This study aimed to examine the correlation between cognitive impairment and diffusion parameters obtained on diffusion tensor imaging (DTI) of abnormal white matter tracts in CKD patients. Methods Sixty-four patients with CKD were divided into the non-dialysis-dependent CKD (NDD-CKD) group (N = 26) and dialysis-dependent CKD (DD-CKD) group (N = 38) according to the estimated glomerular filtration rate, whereas 43 healthy control subjects (normal control [NC]) were included and underwent cranial magnetic resonance imaging during the same period. Differences in the abnormal white matter microstructure and correlations between them and cognitive scores were assessed using several parameters between the groups. Results There were more extensive peri-lesions and distant white matter microstructural changes in the DD-CKD and NDD-CKD groups than in the NC group. DTI diffusion parameters in abnormal white matter regions were associated with impaired cognitive function in CKD patients. The DD-CKD group had worse cognitive function and more severe microstructural damage in the cerebral white matter than the NDD-CKD group. Conclusion CKD patients showed cognitive impairment and changes in the brain white matter microstructure; CKD can lead to extensive white matter tract damage. Additionally, diffusion parameters can be used as a complement to describe structural brain damage in CKD patients.
Collapse
Affiliation(s)
- Chaoyang Zhang
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Huan Yu
- Department of Radiology, Liangxiang Hospital, Beijing, China
| | - Yan Cai
- Department of Nephrology, The Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
| | - Ning Wu
- Department of Medical Imaging, Yanjing Medical College, Capital Medical University, Beijing, China
| | - Shuang Liang
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Chun Zhang
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Zhiyu Duan
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Zhou Zhang
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China,*Correspondence: Guangyan Cai
| |
Collapse
|