The Cerebrovascular-Chronic Kidney Disease Connection: Perspectives and Mechanisms

Lau, Wei Ling; Huisa, Branko; Fisher, Mark

doi:10.1007/s12975-016-0499-x

Cited by 95 publications

(132 citation statements)

References 117 publications

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“…Our results confirm that cerebral microbleeds can be commonly found in patients with chronic kidney failure, especially in dialytic patients [31]. This association was not related to the presence of other CMB risk factors such as other neurological diseases [32].…”

Section: Discussionsupporting

confidence: 83%

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Assessment of cerebral microbleeds by susceptibility-weighted imaging at 3T in patients with end-stage organ failure

Sparacia

Cannella

et al. 2018

Radiol med

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Purpose Cerebral microbleeds (CMBs) are small rounded lesions representing cerebral hemosiderin deposits surrounded by macrophages that results from previous microhemorrhages. The aim of this study was to review the distribution of cerebral microbleeds in patients with end-stage organ failure and their association with specific end-stage organ failure risk factors. Materials and methods Between August 2015 and June 2017, we evaluated 15 patients, 9 males, and 6 females, (mean age 65.5 years). Patients population was subdivided into three groups according to the organ failure: (a) chronic kidney failure (n = 8), (b) restrictive cardiomyopathy undergoing heart transplantation (n = 1), and (c) end-stage liver failure undergoing liver transplantation (n = 6). The MR exams were performed on a 3T MR unit and the SWI sequence was used for the detection of CMBs. CMBs were subdivided in supratentorial lobar distributed, supratentorial non-lobar distributed, and infratentorial distributed. Results A total of 91 microbleeds were observed in 15 patients. Fifty-nine CMBs lesions (64.8%) had supratentorial lobar distribution, 17 CMBs lesions (18.8%) had supratentorial non-lobar distribution and the remaining 15 CMBs lesions (16.4%) were infratentorial distributed. An overall predominance of supratentorial multiple lobar localizations was found in all types of end-stage organ failure. The presence of CMBs was significantly correlated with age, hypertension, and specific end-stage organ failure risk factors (p < 0.001). Conclusions CMBs are mostly founded in supratentorial lobar localization in end-stage organ failure. The improved detection of CMBs with SWI sequences may contribute to a more accurate identification of patients with cerebral risk factors to prevent complications during or after the organ transplantation.

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Section: Discussionsupporting

confidence: 83%

“…In the chronic kidney failure population, diminished estimated glomerular filtration rate has been found to be a risk factor for CMBs [31]. Moreover, chronic kidney failure is correlated with the number of CMBs, thus, the number of CMBs can provide an indirect estimation of chronic kidney failure severity [33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Assessment of cerebral microbleeds by susceptibility-weighted imaging at 3T in patients with end-stage organ failure

Sparacia

Cannella

et al. 2018

Radiol med

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“…In contrast, this effect could subsequently jeopardize the functionality of glomerulus cells and surrounding Bowman's capsules. However, this study elucidated that rt‐PA is not harmful to the kidneys in patients with stroke regardless of age and comorbidity; this result might relate to the endothelium of the glomerulus and BBB, which share similar transmembrane and cytoplasmic anchoring proteins …”

Section: Discussionmentioning

confidence: 99%

Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis

et al. 2019

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Aim Recombinant tissue plasminogen activator (rt‐PA) administration is the most prevalent treatment for acute ischemic within golden time. However, the effects of rt‐PA on the kidney function in such patients remain unknown. This study determined long‐term renal outcomes in patients with acute ischemic stroke receiving systemic rt‐PA. Methods We enroled patients who were hospitalized for acute ischemic stroke from January 2001 to January 2017. We applied 1:2 propensity score matching to eliminate various confounding variables. We defined surrogate renal outcomes as declining of estimated glomerular filtration rate (eGFR) greater than 30% and 50%, and chronic kidney disease (CKD) with eGFR less than 60 mL/min. We then compared the 1‐year eGFR with paired t‐test in patients treated with or without rt‐PA. Results Overall, 343 of 1739 patients received rt‐PA within golden time. After 1:2 propensity score matching, their baseline characteristics were grouped as treated with rt‐PA (n = 235) or not (n = 394). rt‐PA‐treated patients exhibited slower renal progression, including the risk of eGFR declining greater than 30% (hazard ratio (HR), 0.72; P = 0.03), risk of declining eGFR greater than 50% (HR, 0.63; P = 0.046) and risk of CKD (HR, 0.61; P = 0.005). After 1‐year cohort, the rt‐PA group exhibited an improved renal outcome by the paired t‐test (propensity match: ΔGFR = 9.1 (95% confidence interval: 6.3, 11.8), P < 0.001 in rt‐PA group; ΔGFR = −1.1 (95% confidence interval: −2.9, 0.7), P = 0.23 in non‐rt‐PA group). In patients with eGFR less than 45 mL/min (n = 34), intracerebral haemorrhage was not reported. Conclusion Patients receiving rt‐PA for acute ischemic stroke exhibit favourable renal outcomes, and no increased incidence of intracerebral haemorrhage occurs in rt‐PA patients with advanced CKD.

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“…The prevalence may double by 2035 with the anticipated increase in diabetic and older population . Chronic kidney disease has been associated with accelerated atherosclerosis, cognitive impairment, cerebrovascular disease, cardiovascular disease, and mortality . In the eye, patients with CKD have higher risks of cataract, glaucoma, AMD, retinopathies, and visual impairment .…”

Section: Introductionmentioning

confidence: 99%

Early retinal microvascular abnormalities in patients with chronic kidney disease

Yeung

Sun

et al. 2019

Microcirculation

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ObjectiveTo evaluate early retinal microvascular abnormalities in patients with chronic kidney disease (CKD) via optical coherence tomography angiography.MethodsA cross‐sectional study. Two hundred patients with CKD stage ≧3 were enrolled in the CKD group, and 50 age‐matched healthy subjects were enrolled in the control group. Main outcome measures were the differences in parafoveal vessel densities in the superficial vascular plexus (SVP) and deep vascular plexus (DVP) between the CKD and control groups.ResultsThe mean ages were 62.7 ± 10.1 in the CKD group and 61.9 ± 9.7 (P = 0.622) in the control group. The CKD group had reduced parafoveal vessel densities in SVP (46.7 ± 4.3 vs 49.7 ± 2.9, P < 0.001) and DVP (50.1 ± 4.1 vs 52. 6 ± 2.9, P < 0.001) when compared to those of the control group. In multiple linear regression models, age, diabetes, estimated glomerular filtration rate, and use of anti‐hypertensive drugs were factors associated with vessel density in SVP, whereas age, diabetes, and smoking were factors associated with vessel density in DVP.ConclusionPatients with CKD had reduced vessel densities in parafoveal SVP and DVP, as compared to that of control subjects. Microvasculature in the different retinal layers may be affected by different systemic factors.

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The Cerebrovascular-Chronic Kidney Disease Connection: Perspectives and Mechanisms

Cited by 95 publications

References 117 publications

Assessment of cerebral microbleeds by susceptibility-weighted imaging at 3T in patients with end-stage organ failure

Assessment of cerebral microbleeds by susceptibility-weighted imaging at 3T in patients with end-stage organ failure

Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis

Early retinal microvascular abnormalities in patients with chronic kidney disease

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