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 >or=60 mL/min/1.73 m(2): 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.

Fig. 1

Age-standardized odds ratio of SBI, categorized by eGFR and systolic BP (sBP) (eGFR ≥60, 15–59, <15 mL/min/1.73 m²) and (sBP ≥140, <140 mmHg). Numbers of patients in each column were 58, 77 and 37 (left to right) for the near side (sBP <140 mmHg) and 43, 83 and 77 (left to right) for the far side (sBP ≥140 mmHg). The odds ratio of SBI for each column versus ≥60 mL/min/1.73 m² and sBP <140 mmHg was 1.00, 1.63 and 2.86 (left to right) for the near side (sBP <140 mmHg) and 2.17, 3.17 and 3.90 (left to right) for the far side (sBP ≥140 mmHg).