Age-Specific Associations of Renal Impairment and Cerebral Small Vessel Disease Burden in Chinese with Ischaemic Stroke

J Stroke Cerebrovasc Dis. 2019 May;28(5):1274-1280. doi: 10.1016/j.jstrokecerebrovasdis.2019.01.018. Epub 2019 Mar 8.

Abstract

Background: Recent studies in Caucasians with transient ischaemic attack or ischaemic stroke have demonstrated significant age-specific associations between cerebral small vessel disease (SVD) burden on magnetic resonance imaging and renal impairment. We aimed to validate these findings in a large cohort of Chinese with ischaemic stroke.

Methods: In 959 Chinese with ischaemic stroke who received a brain magnetic resonance imaging at the University of Hong Kong, we determined the age-specific associations of renal impairment (glomerular filtration rate < 60 mL/min/1.73 m2) with neuroimaging markers of SVD as well as with the SVD score.

Results: Although renal impairment was associated with the SVD score in univariate analysis in all patients (odds ratio 1.61, 95% confidence interval 1.24-2.09, P < .0001), these associations were attenuated after adjusting for age and sex (P = .38). Similar findings were noted in patients with ischaemic stroke due to SVD and non-SVD subtypes. However, in 222 of 959 patients aged <60, renal impairment was independently associated with an increasing microbleed (adjusted odds ratio 6.82, 2.26-20.59), subcortical (4.97, 1.62-15.24) periventricular white matter hyperintensity (3.96, 1.08-14.51) and global SVD burden (3.41, 1.16-10.04; all P < .05) even after adjusting for age, sex, and vascular risk factors. Nevertheless, there were no associations between renal impairment and individual neuroimaging markers of SVD nor with the SVD score in patients aged ≥60 after adjusting for age and sex (all P > .05).

Conclusions: In Chinese with ischaemic stroke, renal impairment was independently associated with microbleed, white matter hyperintensity and global SVD burden in individuals aged <60, but not in those aged ≥60, suggesting that there may be shared susceptibilities to premature systemic disease.

Keywords: Cerebral small vessel disease; Chronic kidney disease; Magnetic; Renal impairment; Resonance imaging; Stroke.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Asian Continental Ancestry Group
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / ethnology*
  • Brain Ischemia / physiopathology
  • Cerebral Small Vessel Diseases / diagnostic imaging
  • Cerebral Small Vessel Diseases / ethnology*
  • Cross-Sectional Studies
  • Diffusion Magnetic Resonance Imaging
  • Female
  • Glomerular Filtration Rate*
  • Hong Kong / epidemiology
  • Humans
  • Kidney / physiopathology*
  • Kidney Diseases / diagnosis
  • Kidney Diseases / ethnology*
  • Kidney Diseases / physiopathology
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Stroke / diagnostic imaging
  • Stroke / ethnology*
  • Stroke / physiopathology