Cerebral small vessel disease and chronic kidney disease

Abstract

Chronic kidney disease, defined by a decreased glomerular filtration rate or albuminuria, is recognized as a major global health burden, mainly because it is an established risk factor for cardiovascular and cerebrovascular diseases. The magnitude of the effect of chronic kidney disease on incident stroke seems to be higher in persons of Asian ethnicity. Since the kidney and brain share unique susceptibilities to vascular injury due to similar anatomical and functional features of small artery diseases, kidney impairment can be predictive of the presence and severity of cerebral small vessel diseases. Chronic kidney disease has been reported to be associated with silent brain infarcts, cerebral white matter lesions, and cerebral microbleeds, independently of vascular risk factors. In addition, chronic kidney disease affects cognitive function, partly via the high prevalence of cerebral small vessel diseases. Retinal artery disease also has an independent relationship with chronic kidney disease and cognitive impairment. Stroke experts are no longer allowed to be ignorant of chronic kidney disease. Close liaison between neurologists and nephrologists can improve the management of cerebral small vessel diseases in kidney patients.

Keywords: Acute stroke; Asian; Cognitive impairment; Dementia; Lacunar infarction; Retinopathy.

Figure 1

The prevalence of eGFR <60 mL/min/1.73 m² in the general population and stroke patients. Orange bars indicate data from Japanese subjects. Mean age (years): [2] 70.1 (overall stroke), [7] 66, [8] 66.0, [9] 71.4, [10] 70.0, [11] 71.7, [12] 65.6, [13] 46.2, [14] 50.2. From reference 3 with permission.