Adults With Late Stage 3 Chronic Kidney Disease Are at High Risk for Prevalent Silent Brain Infarction: A Population-Based Study

Background and Purpose— The close relationship between stroke and chronic kidney disease (CKD) has been well-documented. However, few studies have focused on silent brain infarction (SBI) in CKD. We investigated the prevalence of SBI in different stages of CKD. Methods— We included 1312 participants aged 30 to 93 years who came from either a random sample of residents or from a group of physically examined subjects in the same community. Basic information, clinical evaluations, laboratory tests, and MRI images were assessed. Subjects were divided into groups 1, 2, 3a, and 3b, corresponding to the estimated glomerular filtration rate (eGFR) levels of ≥90.0, 60.0 to 89.9, 45.0 to 59.9, and 30.0 to 44.9 mL/min/1.73 m2. Results— The crude prevalence was 4.7%: 2.6% (20 of 759 subjects) in group 1; 6.3% (32 of 506) in group 2; 12.9% (4 of 31) in group 3a; and 37.5% (6 of 16) in group 3b (P<0.001). Additionally, SBI also correlated with age, male sex, hypertension, diabetes, moderate carotid plaque, higher blood pressures, obesity, and levels of triglyceride, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and uric acid (all P<0.05). The effects for SBI risk in each eGFR group versus group 1 did not increase except for group 3b (OR, 9.34; P<0.001). Conclusions— A close association exists between SBI and eGFR. We have found a significant increase in prevalence of SBI when eGFR is between 30.0 and 44.9 mL/min/1.73 m2. Adults with late stage 3 CKD are at high risk for prevalent SBI.

[1]  M. M. Lemos,et al.  Intima-Media Thickness Is Associated with Inflammation and Traditional Cardiovascular Risk Factors in Non-Dialysis-Dependent Patients with Chronic Kidney Disease , 2010, Nephron Clinical Practice.

[2]  K. Kashiwagi,et al.  Correlation between images of silent brain infarction, carotid atherosclerosis and white matter hyperintensity, and plasma levels of acrolein, IL-6 and CRP. , 2010, Atherosclerosis.

[3]  Douglas W Mahoney,et al.  Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. , 2003, JAMA.

[4]  M. Walsh,et al.  Chronic Kidney Disease and the Risk of Heart Failure in Men , 2011, Circulation. Heart failure.

[5]  H. Bokura,et al.  Subcortical silent brain infarction as a risk factor for clinical stroke. , 1997, Stroke.

[6]  Y. Hamamoto,et al.  Relationship Between CarotidIntima-Media Thickness and Silent Cerebral Infarction in Japanese Subjects With Type 2 Diabetes , 2009, Diabetes Care.

[7]  L. Truong,et al.  Role of the microvascular endothelium in progressive renal disease. , 2002, Journal of the American Society of Nephrology : JASN.

[8]  P. Koudstaal,et al.  Silent brain infarcts: a systematic review , 2007, The Lancet Neurology.

[9]  Curt D. Furberg,et al.  Incidence, Manifestations, and Predictors of Brain Infarcts Defined by Serial Cranial Magnetic Resonance Imaging in the Elderly: The Cardiovascular Health Study , 2002, Stroke.

[10]  M. Domanski,et al.  The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. , 2000, Journal of the American College of Cardiology.

[11]  M. Lastilla Lacunar Infarct , 2006, Clinical and experimental hypertension.

[12]  R. Kronmal,et al.  Silent brain infarction on magnetic resonance imaging and neurological abnormalities in community-dwelling older adults. The Cardiovascular Health Study. CHS Collaborative Research Group. , 1997, Stroke.

[13]  Hui Ting Chan,et al.  All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan , 2008, The Lancet.

[14]  S. Fujii,et al.  White matter changes in elderly people: MR-pathologic correlations. , 2006, Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine.

[15]  K. Sugimura,et al.  Silent cerebral infarction predicts vascular events in hemodialysis patients. , 2005, Kidney international.

[16]  Wiro J Niessen,et al.  Kidney Function Is Related to Cerebral Small Vessel Disease , 2008, Stroke.

[17]  I. Knottnerus,et al.  Endothelial Dysfunction in Lacunar Stroke: A Systematic Review , 2009, Cerebrovascular Diseases.

[18]  Matthijs Oudkerk,et al.  Incidence and Risk Factors of Silent Brain Infarcts in the Population-Based Rotterdam Scan Study , 2003, Stroke.

[19]  M. Criqui,et al.  The differential association of kidney dysfunction with small and large arterial elasticity: the multiethnic study of atherosclerosis. , 2009, American journal of epidemiology.

[20]  K. Nitta,et al.  Arterial stiffness in patients with non-diabetic chronic kidney disease (CKD). , 2009, Journal of atherosclerosis and thrombosis.

[21]  W. Rand,et al.  Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. , 2001, Journal of the American College of Cardiology.

[22]  William Stewart,et al.  Recommendations for chamber quantification. , 2006, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[23]  S. Rajagopalan,et al.  Dominance of traditional cardiovascular risk factors over renal function in predicting arterial stiffness in subjects with chronic kidney disease. , 2010, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[24]  Charles E. McCulloch,et al.  Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. , 2004, The New England journal of medicine.

[25]  V. Roger,et al.  Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. , 2009, Journal of the American College of Cardiology.

[26]  J. Butler,et al.  Risk Factors for Development of Heart Failure , 2007 .

[27]  D. Levy,et al.  Arterial stiffness in mild-to-moderate CKD. , 2009, Journal of the American Society of Nephrology : JASN.

[28]  Kdoqi Disclaimer K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[29]  Tom Greene,et al.  Using Standardized Serum Creatinine Values in the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate , 2006, Annals of Internal Medicine.

[30]  K. Sugimura,et al.  Silent Cerebral Infarction in Hemodialysis Patients , 2003, American Journal of Nephrology.

[31]  R. Khalil,et al.  Inflammatory cytokines in vascular dysfunction and vascular disease. , 2009, Biochemical pharmacology.

[32]  J. Seward,et al.  Usefulness of left atrial volume in predicting first congestive heart failure in patients > or = 65 years of age with well-preserved left ventricular systolic function. , 2005, The American journal of cardiology.

[33]  Jiang He,et al.  Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. , 2002, Journal of the American Society of Nephrology : JASN.

[34]  W. Abhayaratna,et al.  Characteristics of left ventricular diastolic dysfunction in the community: an echocardiographic survey , 2006, Heart.

[35]  L. Kuller,et al.  Access www.neurology.org now for full-text articles , 2001, Neurology.

[36]  M. Schwaninger,et al.  Influenza Virus Infection Aggravates Stroke Outcome , 2011, Stroke.

[37]  Ethan M Balk,et al.  K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[38]  A. Charlesworth,et al.  Renal function, neurohormonal activation, and survival in patients with chronic heart failure. , 2000, Circulation.

[39]  L. Kurland,et al.  The patient record in epidemiology. , 1981, Scientific American.

[40]  Serguei V. S. Pakhomov,et al.  Systolic and diastolic heart failure in the community. , 2006, JAMA.

[41]  William T. Abraham,et al.  Focused Update : ACCF / AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults , 2013 .

[42]  T. Ohtake,et al.  Asymptomatic cerebral lacunae in patients with chronic kidney disease. , 2004, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[43]  Jeffrey L Saver,et al.  Stroke Declines From Third to Fourth Leading Cause of Death in the United States: Historical Perspective and Challenges Ahead , 2011, Stroke.

[44]  H. Chiou,et al.  A significant decrease in blood pressure through a family-based nutrition health education programme among community residents in Taiwan , 2009, Public Health Nutrition.

[45]  R. Starling,et al.  Prognostic evaluation of ambulatory patients with advanced heart failure. , 2008, The American journal of cardiology.

[46]  K. Swedberg,et al.  Heart failure with preserved left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. , 2004, Journal of the American College of Cardiology.

[47]  L. Tomlinson,et al.  Aortic Stiffness Is Independently Associated With Rate of Renal Function Decline in Chronic Kidney Disease Stages 3 and 4 , 2010, Hypertension.

[48]  P. Scheltens,et al.  LOW VITAMIN B6 LEVELS ARE ASSOCIATED WITH WHITE MATTER LESIONS IN ALZHEIMER'S DISEASE , 2005, Journal of the American Geriatrics Society.

[49]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2009, Circulation.

[50]  M. Herregods,et al.  Prevalence of Left Ventricular Diastolic Dysfunction in a General Population , 2009, Circulation. Heart failure.

[51]  J. A. Oliver,et al.  Silent cerebral white matter lesions and their relationship with vascular risk factors in middle-aged predialysis patients with CKD. , 2006, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[52]  H. Bokura,et al.  Metabolic Syndrome Is Associated With Silent Ischemic Brain Lesions , 2008, Stroke.

[53]  E. Wijdicks,et al.  Subtherapeutic International Normalized Ratio in Warfarin-Treated Patients Increases the Risk for Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis , 2011, Stroke.

[54]  D. Kitzman,et al.  The pathogenesis of acute pulmonary edema associated with hypertension. , 2001, The New England journal of medicine.

[55]  K. Bailey,et al.  Diastolic heart failure in the community: clinical profile, natural history, therapy, and impact of proposed diagnostic criteria. , 2002, Journal of cardiac failure.

[56]  W. Gaasch,et al.  Diastolic heart failure--abnormalities in active relaxation and passive stiffness of the left ventricle. , 2004, The New England journal of medicine.

[57]  F. Fazekas,et al.  Pathologic correlates of incidental MRI white matter signal hyperintensities , 1993, Neurology.

[58]  Response to Letter by Romanens Regarding Article, “Carotid Plaque Area and Intima-Media Thickness in Prediction of First-Ever Ischemic Stroke: A 10-Year Follow-Up of 6584 Men and Women: The Tromsø Study” , 2011 .

[59]  Tatsuo Yamaguchi,et al.  Are serum cholesterol levels associated with silent brain infarcts? The Seiryo Clinic Study. , 2010, Atherosclerosis.

[60]  L. Melton,et al.  History of the Rochester Epidemiology Project. , 1996, Mayo Clinic proceedings.

[61]  P. Matthews,et al.  White matter lesion progression, brain atrophy, and cognitive decline: The Austrian stroke prevention study , 2005, Annals of neurology.

[62]  Y. Toya,et al.  Relationship between silent brain infarction and chronic kidney disease , 2008, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[63]  T. Marwick,et al.  Evolution and outcome of diastolic dysfunction , 2008, Heart.

[64]  P. Armstrong,et al.  Renal Insufficiency and Heart Failure: Prognostic and Therapeutic Implications From a Prospective Cohort Study , 2004, Circulation.

[65]  M. Klein Cerebral Microvascular Disease Predicts Renal Failure in Type 2 Diabetes , 2011 .

[66]  M. Redfield,et al.  Epidemiology of diastolic heart failure. , 2005, Progress in cardiovascular diseases.

[67]  Z. Massy,et al.  Relationship between silent brain infarction and chronic kidney disease. , 2009, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[68]  R. Kronmal,et al.  The Cardiovascular Health Study: design and rationale. , 1991, Annals of epidemiology.

[69]  R. Poveda,et al.  Goodpasture syndrome during the course of a Schönlein-Henoch purpura. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[70]  D. Levy,et al.  Natural History of Asymptomatic Left Ventricular Systolic Dysfunction in the Community , 2003, Circulation.

[71]  C. DeCarli,et al.  Chronic Kidney Disease Is Associated With White Matter Hyperintensity Volume: The Northern Manhattan Study (NOMAS) , 2007, Stroke.

[72]  H. Eskola,et al.  MRI texture analysis in multiple sclerosis: toward a clinical analysis protocol. , 2010, Academic radiology.

[73]  B. Coll,et al.  Cardiovascular risk factors underestimate atherosclerotic burden in chronic kidney disease: usefulness of non-invasive tests in cardiovascular assessment. , 2010, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[74]  A. Deswal Diastolic dysfunction and diastolic heart failure: Mechanisms and epidemiology , 2005, Current cardiology reports.

[75]  Yasuhiko Takemoto,et al.  Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography. , 2003, Journal of the American College of Cardiology.

[76]  Takeo Kato,et al.  Cerebral small vessel disease and chronic kidney disease (CKD): Results of a cross-sectional study in community-based Japanese elderly , 2008, Journal of the Neurological Sciences.

[77]  Seung-Hoon Lee,et al.  Metabolic syndrome as an independent risk factor of silent brain infarction in healthy people. , 2006, Stroke.

[78]  A. Coats,et al.  The epidemiological enigma of heart failure with preserved systolic function , 2004, European journal of heart failure.

[79]  M. Senni,et al.  Heart failure with preserved systolic function. A different natural history? , 2001, Journal of the American College of Cardiology.

[80]  E. Schiffrin,et al.  Chronic Kidney Disease: Effects on the Cardiovascular System , 2007, Circulation.

[81]  A. Levey,et al.  A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation , 1999, Annals of Internal Medicine.

[82]  M. Arnold,et al.  Impact of Obesity on Stroke Outcome After Intravenous Thrombolysis , 2011, Stroke.