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.
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.
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.
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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- Decreased kidney function is a significant factor associated with silent cerebral infarction and periventricular hyperintensities.Kidney Blood Press Res. 2011; 34: 430-438
- Relationship between chronic kidney disease and silent cerebral infarction in patients with type 2 diabetes.Diabet Med. 2010; 27: 538-543
- Chronic kidney disease and clinical outcome in patients with acute stroke.Stroke. 2009; 40: 1296-1303
- Strain vessel hypothesis: a viewpoint for linkage of albuminuria and cerebro-cardiovascular risk.Hypertens Res. 2009; 32: 115-121
- Association of white matter hyperintensity volume with decreased cognitive functioning: the Framingham Heart Study.Arch Neurol. 2006; 63: 246-250
- Cerebral white matter lesions and the risk of dementia.Arch Neurol. 2004; 61: 1531-1534
- Silent brain infarcts and white matter lesions increase stroke risk in the general population: the Rotterdam Scan Study.Stroke. 2003; 34: 1126-1129
- Chronic kidney disease is associated with white matter hyperintensity volume: the Northern Manhattan Study (NOMAS).Stroke. 2007; 38: 3121-3126
- Cerebral small vessel disease and chronic kidney disease (CKD): results of a cross-sectional study in community-based Japanese elderly.J Neurol Sci. 2008; 272: 36-42
- Kidney function is related to cerebral small vessel disease.Stroke. 2008; 39: 55-61
- Relationship between silent brain infarction and chronic kidney disease.Nephrol Dial Transplant. 2009; 24: 201-207
- Impaired kidney function and cerebral microbleeds in patients with acute ischemic stroke.Neurology. 2009; 73: 1645-1648
- Strong independent correlation of proteinuria with cerebral microbleeds in patients with stroke and transient ischemic attack.Arch Neurol. 2010; 67: 45-50
- Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration.Lancet Neurol. 2013; 12: 822-838
- MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging.AJR Am J Roentgenol. 1987; 149: 351-356
- Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden.Neurology. 2014; 83: 1228-1234
- Clinical interaction between brain and kidney in small vessel disease.Cardiol Res Pract. 2011; 2011 (306189)
- Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges.Lancet Neurol. 2010; 9: 689-701
- Nitric oxide deficiency in chronic kidney disease.Am J Physiol Renal Physiol. 2008; 294: F1-F9
- Neurovascular and neurometabolic derailment in aging and Alzheimer's disease.Front Aging Neurosci. 2015; 7: 103
- Endothelial nitric oxide gene haplotypes and risk of cerebral small-vessel disease.Stroke. 2004; 35: 654-659
- Cerebral microbleeds in predialysis patients with chronic kidney disease.Nephrol Dial Transplant. 2010; 25: 1554-1559
- Association of chronic kidney disease with cerebral microbleeds in patients with primary intracerebral hemorrhage.Stroke. 2013; 44: 2409-2413
- Cerebral small vessel disease and kidney function predict long-term survival in patients with acute stroke.Stroke. 2010; 41: 1914-1920
- Incidence of silent lacunar lesion in normal adults and its relation to cerebral blood flow and risk factors.Stroke. 1991; 22: 1379-1383
- Long-term prognosis of first-ever lacunar strokes. A hospital-based study.Stroke. 1996; 27: 661-666
- Cerebral microbleeds are predictive of mortality in the elderly.Stroke. 2011; 42: 638-644
- MRI biomarkers of vascular damage and atrophy predicting mortality in a memory clinic population.Stroke. 2009; 40: 492-498
- Diffuse axonal injury associated with chronic traumatic brain injury: evidence from T2*-weighted gradient-echo imaging at 3 T.AJNR Am J Neuroradiol. 2003; 24: 1049-1056
- MR detection of microhemorrhages in neurologically healthy adults.Neuroradiology. 2002; 44: 31-36
Published online: October 25, 2016
Accepted: September 22, 2016
Received in revised form: September 9, 2016
Received: July 12, 2016
© 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.