Chronic Kidney Disease as Risk Factor for Enlarged Perivascular Spaces in Patients With Stroke and Relation to Racial Group

Abstract

Background and Purpose: Enlarged perivascular spaces (EPVS) are considered subclinical markers of small vessel disease, associated with increased risk of stroke and dementia. Increasing evidence links chronic kidney disease (CKD) to small vessel disease. We explored the relationship between CKD and EPVS burden and the influence of racial group in this relation. Methods: Consecutive patients with stroke who underwent brain magnetic resonance imaging were included (n=894). Racial group was categorized as White, Black, or other (other racial groups). CKD was defined by glomerular filtration rate <60 mL/minute per 1.73 m 2 for >3 months. EPVS were rated following a standardized method, dichotomized for analyses (mild [<20] versus severe [≥20]), and stratified by brain region (basal ganglia and centrum semiovale). Results: In multivariable-adjusted analysis, the association of CKD with severe EPVS varied across racial groups. Comparing patients with and without CKD within racial groups, we found that Whites with CKD had higher odds of severe centrum semiovale EPVS (odds ratio [OR], 2.41 [95% CI, 0.98–5.88]). Among patients with CKD, Black patients had higher odds of severe EPVS in the basal ganglia and centrum semiovale compared with Whites (OR, 1.93 [95% CI, 1.18–3.16] and OR, 1.90 [95% CI, 1.16–3.11], respectively) and other racial groups (OR, 2.03 [95% CI, 1.23–3.36] and OR, 2.02 [95% CI, 1.22–3.34], respectively). Conclusions: CKD was more prevalent in our sample of patients with stroke with severe EPVS in the centrum semiovale. The relation differed when stratified by racial group and brain topography. Further studies are needed to confirm that CKD may relate differently to subclinical measures of small vessel disease according to race.

Diffusion tensor imaging of the brain white matter microstructure in patients with chronic kidney disease and its correlation with cognition

“…Among these, potential cognitive and psychological impairment (cognitive impairment, CI) is one of the most important psychological problems that affect the quality of life and wellbeing of patients with CKD ( 3 ). Patients with CKD are at a higher risk of cognitive impairment, and older patients on dialysis have the highest absolute risk ( 4 ). Neuroimaging studies have shown that patients with CKD tend to have structural and functional changes, such as white matter hyperintensities, asymptomatic stroke, and brain atrophy ( 5 , 6 ).…”

Glymphatic system in the thalamus, secondary degeneration area was severely impaired at 2nd week after transient occlusion of the middle cerebral artery in rats

“…Fourthly, we did not try to intervene in the key proteins or molecules of the glymphatic system to explore the changes after the intervention and whether the intervention contributes to the recovery of neurological function after ischemic stroke. Fifthly, recently MRI-visible enlarged perivascular space has been proposed as an MRI biomarker of the glymphatic pathway ( Hilal et al, 2018 ; Liu et al, 2018 ; Jochems et al, 2020 ; Penton et al, 2020 ; Troili et al, 2020 ). However, it remains unclear whether enlarged perivascular space reflects glymphatic stasis or rather increased capacity of the perivascular space to drain potentially neurotoxic metabolites.…”

Covert vascular brain injury in chronic kidney disease

“…In a single-center study involving 413 patients with a first-ever acute lacunar stroke, proteinuria and eGFR <60 mL/min/1.73 m 2 were correlated with PVSs severity in both the centrum semiovale and basal ganglia ( 50 ). In a single hospital-based study for acute stroke, white patients with CKD had higher odds of severe centrum-semiovale PVSs when comparing patients with and without CKD within racial groups ( 59 ). Among patients with CKD, black patients had 2-fold higher odds of severe PVSs in the basal ganglia and centrum semiovale compared to whites and other racial groups ( 59 ).…”

“…In a single hospital-based study for acute stroke, white patients with CKD had higher odds of severe centrum-semiovale PVSs when comparing patients with and without CKD within racial groups ( 59 ). Among patients with CKD, black patients had 2-fold higher odds of severe PVSs in the basal ganglia and centrum semiovale compared to whites and other racial groups ( 59 ). In a single hospital-based study for 304 patients with autosomal-dominant polycystic kidney disease (ADPKD), ADPKD was associated with a higher degree of PVSs, but not with the WMHs severity, lacunes, or CMBs, compared to age-, sex-, and eGFR-matched controls, suggesting that ADPKD-associated cilia dysfunction may induce chronic cerebral glymphatic system dysfunction ( 60 ).…”