Prognostic Relationships between Microbleed, Lacunar Infarction, White Matter Lesion, and Renal Dysfunction in Acute Ischemic Stroke Survivors

Jeon, Jae Wan; Jeong, Hye Seon; Choi, Dae Eun; Ham, Young Rok; Na, Ki Young; Lee, Kang Wook; Shin, Jong Wook; Kim, Jei

doi:10.1016/j.jstrokecerebrovasdis.2016.09.037

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…CKD is also highly prevalent in patients with SVD. In a single-centre study of survivors of acute ischaemic stroke, patients with silent lacunar infarction, white matter lesion (WML) or cerebral microbleed (CMB) had significantly lower eGFR than those without such lesions (60.4±34.8 vs 87.5±28.4 mL/min/1.73 m 2 , 60.5±37.1 vs 73.9±33.3 mL/min/1.73 m 2 and 57.6±33.3 vs 73.9±32.9 mL/min/1.73 m 2 , respectively) 12. Even with adjustment for age and vascular risk factors, the OR for the presence of SVD and each subtype increased inversely with eGFR, with the highest prevalence in more advanced CKD.…”

Section: Associations Between Ckd and Cerebrovascular Diseasementioning

confidence: 99%

Disentangling the multiple links between renal dysfunction and cerebrovascular disease

Kelly

Rothwell

2019

J Neurol Neurosurg Psychiatry

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Chronic kidney disease (CKD) has a rapidly rising global prevalence, affecting as many as one-third of the population over the age of 75 years. CKD is a well-known risk factor for cardiovascular disease and, in particular, there is a strong association with stroke. Cohort studies and trials indicate that reduced glomerular filtration rate increases the risk of stroke by about 40% and that proteinuria increases the risk by about 70%. In addition, CKD is also strongly associated with subclinical cerebrovascular abnormalities, vascular cognitive impairment and dementia. The mechanisms responsible for these associations are currently unclear. CKD is associated with traditional risk factors such as hypertension, diabetes mellitus and atrial fibrillation, but non-traditional risk factors such as uraemia, oxidative stress, mineral and bone abnormalities, and dialysis-related factors, such as changes in cerebral blood flow or cardiac structure, are also postulated to play a role. Kidney disease can also impact and complicate the treatments used in acute stroke and in secondary prevention. In this review, we will outline our current understanding of the epidemiology and pathophysiology of cerebrovascular disease in CKD.

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Section: Associations Between Ckd and Cerebrovascular Diseasementioning

confidence: 99%

Disentangling the multiple links between renal dysfunction and cerebrovascular disease

Kelly

Rothwell

2019

J Neurol Neurosurg Psychiatry

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“…26 Third, a strong association between cerebral microbleeds or white matter lesions and CKD has been reported, 27-30 and these are also important risk factors for mortality after AIS. 31,32 This study has several strengths, including the large sample size, the multicenter study design, and also the fact that it has identified an association between higher BUN and in-hospital mortality after AIS. We also recognize some limitations of the present study.…”

Section: Figure 2 Cumulative Incidence Of In-hospital Mortality Accomentioning

confidence: 99%

Prognostic Significance of Blood Urea Nitrogen in Acute Ischemic Stroke

You

Zheng

Zhong

et al. 2018

Circ J

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Background:Prior studies have shown an association between high blood urea nitrogen (BUN) and an elevated risk of mortality in heart failure patients, but data on the prognostic significance of BUN and other markers of kidney function in acute ischemic stroke (AIS) patients are sparse. Methods and Results:A total of 3,355 AIS patients were enrolled from December 2013 to May 2014, across 22 hospitals. Admission BUN was divided into quartiles (Q1, <4.39 mmol/L; Q2, ≥4.39 and <5.40 mmol/L; Q3, ≥5.40 and <6.70 mmol/L and Q4, ≥6.70 mmol/L) and estimated glomerular filtration rate (eGFR), creatinine (Cr) and BUN/Cr were also categorized. Cox proportional hazard and logistic regression models were used to estimate the effect of BUN, eGFR, Cr and BUN/Cr on all-cause in-hospital mortality and poor outcome on discharge (modified Rankin Scale score ≥3) in AIS patients. During hospitalization, 120 patients (3.6%) died from all causes and 1,287 (38.4%) had poor outcome at discharge. BUN was independently associated with all-cause in-hospital mortality (adjusted HR for Q4 vs. Q1, 3.75; 95% CI: 1.53-9.21; P-trend=0.003) but not poor outcome at discharge (P-trend=0.229). No significant association was found, however, between reduced eGFR, increased Cr and BUN/Cr and all-cause in-hospital mortality and poor outcome at discharge (all P-trend ≥0.169). Conclusions:Increased BUN at admission is a significant prognostic factor associated with in-hospital mortality in AIS patients, but not with poor discharge outcome.

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“…The number of participants in eight studies exceeded 1,000, and only two studies had <100 participants. In general, most of the included studies showed that chronic kidney disease was associated with increased severity of WMH; furthermore, the severity of kidney dysfunction was positively correlated with the severity of WMH ( 11 , 16 , 17 , 21 , 23 – 26 , 28 – 30 , 33 – 38 ). However, there was no significant correlation between GFR level and WMH severity in three studies ( 19 , 20 , 27 ).…”

Section: Resultsmentioning

confidence: 99%

Association Between White Matter Hyperintensities and Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Wei

Yan

et al. 2022

Front. Med.

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ObjectivesPrevious studies of the associations between white matter hyperintensities (WMH) and chronic kidney disease (CKD) were still conflicting; therefore, our study aimed to conduct a systematic review of all of the available research on this topic and a meta-analysis of the association between WMH and CKD among observational studies.Setting and DesignSystematic review and meta-analysis.Outcome MeasuresSeverity of WMH.Methods and ParticipantsAll relevant studies in public databases were examined until 15 November 2020. Two independent reviewers assessed all the included studies using the Cross-Sectional/Prevalence Study Quality (CSSQ) scale, and then literature review and meta-analyses were undertaken.ResultsWe pooled the odds ratio (OR) for the presence of WMH, periventricular hyperintensities (PVH), and deep subcortical white matter hyperintensities (DWMH) of patients with CKD vs. non-CKD patients by subgroup analysis, and the results obtained were WMH OR 2.07, 95% CI [1.58, 2.70], PVH OR 2.41, 95% CI [1.90, 3.05], and DWMH OR 2.11, 95% CI [1.60, 2.80], respectively. The main outcome showed that patients with CKD were more likely to have WMH in the brain compared to the normal controls. Another meta-analysis showed a statistically significant decline in renal function in patients with moderate to severe WMH compared with those with no to mild WMH.ConclusionsThe findings indicated that patients with CKD were more likely to experience WMH than demographically matched controls. On the other hand, patients with moderate to severe WMH in the brain had poor renal function more frequently than those with no to mild WMH.

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Prognostic Relationships between Microbleed, Lacunar Infarction, White Matter Lesion, and Renal Dysfunction in Acute Ischemic Stroke Survivors

Cited by 8 publications

References 28 publications

Disentangling the multiple links between renal dysfunction and cerebrovascular disease

Disentangling the multiple links between renal dysfunction and cerebrovascular disease

Prognostic Significance of Blood Urea Nitrogen in Acute Ischemic Stroke

Association Between White Matter Hyperintensities and Chronic Kidney Disease: A Systematic Review and Meta-Analysis

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