Relationship between silent brain infarction and chronic kidney disease

Abstract

Background. The presence of silent brain infarction (SBI) increases the risk of symptomatic stroke and dementia. The association between SBI and chronic kidney disease (CKD) has not been clarified. Moreover, little is known about what factors are related to SBI in CKD patients and whether the prevalence of SBI differs in CKD stage or cause of CKD.Methods. This is a cross-sectional study. A total of 375 subjects—335 with CKD and 40 with essential hypertension—were included. All subjects underwent magnetic resonance imaging (MRI) of the brain to detect SBI. Glomerular filtration rate (GFR) was estimated using Modification of Diet in Renal Disease equation, and cardiovascular risk factors were examined.Results. The prevalence of SBI was 56.5% in all subjects. Among causes of CKD, hypertensive nephrosclerosis had a strong association with SBI. According to the estimated GFR (eGFR) stage, the more severe the stage of eGFR, the higher the prevalence of SBI (age-adjusted odds ratio [95% confidence interval] for eGFR 30–59, 15–29 and <15 versus ≥60 mL/min/1.73 m2: 1.34 [0.68–1.99], 1.94 [1.30–2.57] and 2.51 [1.91–3.10]). In multivariate logistic analysis, eGFR was related to SBI independently, in addition to age and blood pressure (P = 0.025). However, other traditional and non-traditional risk factors were not.Conclusion. There was an independent association between eGFR and SBI. CKD patients should receive active detection of SBI and more intensive preventive management, especially for hypertension, should be needed in CKD patients to prevent SBI.

[P3–344]: Effect of Kidney Dysfunction on Cerebral Cortical Thinning in an Elderly Population

“…Many studies have found that CKD independently contributed to subclinical brain lesions on MRI, such as silent brain infarcts, lacunes, white matter hyperintensities, or cerebral microbleeds 10,11,[31][32][33][34][35] . These were mainly lesions of cerebral small vessel disease and could lead to brain atrophy and cortical thinning 36 .…”

Risk of &ldquo;silent stroke&rdquo; in patients older than 60 years: risk assessment and clinical perspectives

“…The authors suggested that the hemodynamic stress to these vascular beds could result in small-vessel injuries to both brain and kidney. 15 Migraine was also associated with SBI. Among the patients with migraine with aura (MA), 8.1% of 161 subjects showed silent lesions.…”

“…15 In another study, 25% of patients with a creatinine clearance (CCr) . 40 mL/min/1.73 m 2 showed SBI, 85% with a CCr , 40 mL/min/1.73 m essential hypertension (HTN) and normal renal function.…”

“…17 As for the mechanism, it was suggested that brain and kidney had similar anatomical and physiological vascular beds, and this could be the reason for SBI. 15 HTN, especially systolic blood pressure (BP), was strongly correlated with the prevalence of SBI in the patients with CKD. High blood flow is constantly perfused through the low-resistance vascular beds throughout systole and diastole.…”

“Does chronic kidney disease define a particular risk pattern of cerebral vessels modifications in patients with symptomatic ischemic cerebrovascular disease?”

“…Hypertension plays an important role in the occurrence of silent brain infarction (a small vessel disease of the brain). This fact is more prominent in patients with CKD and is indicative of a cerebro-renal association, thus establishing a link between vascular disease of the kidney and the brain [31].…”