Abstract
Background: Cerebral microbleeds (CMBs) are associated with the risk of intracerebral hemorrhage
in stroke patients with atrial fibrillation (AF). We investigated the association
between CMBs and chronic kidney disease (CKD) in patients with acute ischemic stroke
and AF. Methods: We retrospectively examined consecutive patients with acute ischemic stroke and AF
who underwent brain gradient-echo T2*-weighted magnetic resonance imaging. The number
and distribution (lobar, deep or infratentorial, and mixed) of CMBs were assessed.
Kidney function was assessed according to the estimated glomerular filtration rate
(eGFR), which was calculated using a modified version of the Modification of Diet
in Renal Disease equation. Results: Of the 357 included patients, 105 (29.4%) had CMBs. CKD (eGFR < 60 mL/min/1.73 m2) was found in 131 (36.7%) patients. Patients with CKD showed a higher prevalence
of any form of CMB (41.2% versus 22.6%, P < .001), deep or infratentorial CMBs (19.9% versus 9.3%, P < .01), and mixed CMBs (14.5% versus 5.3%, P < .01) than those without CKD. After adjusting for age and other confounding factors,
CKD was found to be independently associated with the presence of any form of CMB
(odds ratio 1.89, P = .02) and mixed CMBs (odds ratio 3.10, P < .01). Moreover, moderate to severe CKD (eGFR < 45 mL/min/1.73 m2) was independently associated with the presence of multiple CMBs (odds ratio 2.31,
P = .04). Conclusions: CMBs and CKD are common in acute ischemic stroke patients with AF, and CKD may be
a risk factor for CMBs. Further longitudinal studies are needed to evaluate whether
maintaining kidney function can prevent the development of CMBs.
Key Words
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References
- Atrial fibrillation as a predictive factor for severe stroke and early death in 15,831 patients with acute ischaemic stroke.J Neurol Neurosurg Psychiatry. 2005; 76: 679-683
- Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.Ann Intern Med. 2007; 146: 857-867
- Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.Lancet. 2014; 383: 955-962
- Preadmission antithrombotic treatment and stroke severity in patients with atrial fibrillation and acute ischaemic stroke: an observational study.Lancet Neurol. 2006; 5: 749-754
- Adequate adherence to direct oral anticoagulant is associated with reduced ischemic stroke severity in patients with atrial fibrillation.J Stroke Cerebrovasc Dis. 2019; 28: 1773-1780
- Death and disability from warfarin-associated intracranial and extracranial hemorrhages.Am J Med. 2007; 120: 700-705
- Atrial fibrillation and microbleeds.Stroke. 2017; 48: 2660-2664
- The frequency of cerebral microbleeds increases with CHADS(2) scores in stroke patients with non‐valvular atrial fibrillation.Eur J Neurol. 2013; 20: 502-508
- Brain microbleeds, anticoagulation, and hemorrhage risk: meta-analysis in stroke patients with AF.Neurology. 2017; 89: 2317-2326
- Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study.Lancet Neurol. 2018; 17: 539-547
- Cerebral microbleeds: a guide to detection and interpretation.Lancet Neurol. 2009; 8: 165-174
- Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds.AJNR Am J Neuroradiol. 1999; 20: 637-642
- Prevalence and risk factors of cerebral microbleeds: an update of the Rotterdam scan study.Stroke. 2010; 41: S103-S106
- Associations of durations of antiplatelet use and vascular risk factors with the presence of cerebral microbleeds.J Stroke Cerebrovasc Dis. 2014; 23: 433-440
- Cerebral microbleeds and recurrent stroke risk: systematic review and meta-analysis of prospective ischemic stroke and transient ischemic attack cohorts.Stroke. 2013; 4: 995-1001
- Stroke and cerebrovascular diseases in patients with chronic kidney disease.Lancet Neurol. 2014; 13: 823-833
- Low glomerular filtration rate and risk of stroke: meta-analysis.BMJ. 2010; 341: c4249
- Impaired kidney function and cerebral microbleeds in patients with acute ischemic stroke.Neurology. 2009; 73: 1645-1648
- Deep cerebral microbleeds and renal dysfunction in patients with acute lacunar infarcts.J Stroke Cerebrovasc Dis. 2015; 24: 2572-2579
- Association of chronic kidney disease with small vessel disease in patients with hypertensive intracerebral hemorrhage.Front Neurol. 2018; 9: 284
- Association of chronic kidney disease with cerebral microbleeds in patients with primary intracerebral hemorrhage.Stroke. 2013; 44: 2409-2413
- Kidney dysfunction and cerebral microbleeds in neurologically healthy adults.PLoS One. 2017; 12e0172210
- Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC).Eur Heart J. 2010; 31: 2369-2429
- Revised equations for estimated GFR from serum creatinine in Japan.Am J Kidney Dis. 2009; 53: 982-992
- The microbleed anatomical rating scale (MARS): reliability of a tool to map brain microbleeds.Neurology. 2009; 73: 1759-1766
- MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging.AJR Am J Roentgenol. 1987; 149: 351-356
- The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report.Kidney Int. 2011; 80: 17-28
- Cerebral microbleeds are uncommon in ischemic stroke associated with nonvalvular atrial fibrillation.J Neuroimaging. 2011; 21: 103-107
- Prevalence of atrial fibrillation and association of previous antithrombotic treatment in patients with cerebral microbleeds.Eur J Neurol. 2015; 22: 1355-1362
- The clinical relevance of cerebral microbleeds in patients with cerebral ischemia and atrial fibrillation.J Neurol. 2016; 263: 238-244
- Cerebral microbleeds and white matter hyperintensities in cardioembolic stroke patients due to atrial fibrillation: single-centre longitudinal study.J Neurol Sci. 2016; 369: 263-267
- Prevalence of brain MRI markers of hemorrhagic risk in patients with stroke and atrial fibrillation.Front Neurol. 2016; 7: 151
- International comparison of the relationship of chronic kidney disease prevalence and ESRD risk.J Am Soc Nephrol. 2006; 17: 2275-2284
- Prevalence of chronic kidney disease in the Japanese general population.Clin Exp Nephrol. 2009; 13: 621-630
- Which patients with atrial fibrillation and chronic kidney disease should receive anticoagulation—and with which anticoagulant?.Can J Cardiol. 2017; 33: 211-213
- Prevalence of renal dysfunction in ischaemic stroke and transient ischaemic attack patients with or without atrial fibrillation.Eur J Neurol. 2015; 22: 64-69
- Chronic kidney disease as an independent risk factor for new-onset atrial fibrillation in hypertensive patients.J Hypertens. 2010; 28: 1738-1744
- Stroke and bleeding in atrial fibrillation with chronic kidney disease.N Engl J Med. 2012; 367: 625-635
- The cerebrovascular-chronic kidney disease connection: perspectives and mechanisms.Transl Stroke Res. 2017; 8: 67-76
- Mixed-location cerebral hemorrhage/microbleeds: underlying microangiopathy and recurrence risk.Neurology. 2018; 90: e119-e126
- Serum cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment.Am J Kidney Dis. 2000; 36: 29-34
- Acute kidney injury following acute ischemic stroke and intracerebral hemorrhage: a meta-analysis of prevalence rate and mortality risk.Cerebrovasc Dis. 2018; 45: 1-9
- Distribution of cerebral microbleeds in the East and West: individual participant meta-analysis.Neurology. 2019; 92: e1086-e1097
- Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds.Stroke. 2013; 44: 2782-2786
Article info
Publication history
Published online: February 03, 2020
Accepted:
January 6,
2020
Received in revised form:
December 27,
2019
Received:
October 28,
2019
Footnotes
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104650
Copyright
© 2020 Elsevier Inc. All rights reserved.
