The following is a summary of “Associations of Cerebral Small Vessel Disease and Chronic Kidney Disease in Patients With Acute Intracerebral Hemorrhage: A Cross-Sectional Study,” published in the June 2024 issue of Neurology by Nash, et al.
Chronic kidney disease (CKD) is a potential risk factor for the development and severity of small vessel disease (SVD), the most common cause of intracerebral hemorrhage (ICH).
Researchers conducted a retrospective study to explore how CKD relates to features of ICH seen on brain imaging, including the total burden and specific components of SVD.
They examined two groups of consecutive patients with ICH who underwent MRI scans. The study assessed CKD severity using Kidney Disease Improving Global Outcomes criteria, requiring eGFR measurements <60 mL/min/1.732 ≥ 3 months apart. The MRI scans were analyzed for ICH neuroimaging types (arteriolosclerosis, cerebral amyloid angiopathy, mixed location SVD, or cryptogenic ICH and SVD markers (white matter hyperintensities [WMHs], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces, defined by STandards for ReportIng Vascular changes on nEuroimaging criteria). Multinomial, binomial logistic, and ordinal logistic regression models, adjusted for age, sex, hypertension, and diabetes, were used to address potential confounding from shared CKD and SVD risk factors.
The results showed that among 875 patients (mean age 66 years, 42% female), 146 (16.7%) had CKD. Adjusted for age, sex, and comorbidities, patients with CKD had a 2.39 times higher risk of mixed SVD compared to those with eGFR >60 (95% CI 1.16–4.94, P=0.019). More severe WMHs, deep microbleeds, and lacunes were exhibited along with a higher overall SVD burden score (OR 1.83 per point on the ordinal scale, 95% CI 1.31–2.56, P<0.001). Patients with eGFR ≤30 had a median of 7 CMBs (IQR 1–23), significantly more than those with eGFR >30 (median 2, IQR 0–8, P=0.007).
Investigators found CKD to be associated with characteristics of SVD seen on brain imaging in patients with ICH, suggesting a potential role of CKD in SVD development.
Source: neurology.org/doi/10.1212/WNL.0000000000209540
