Adults With Late Stage 3 Chronic Kidney Disease Are at High Risk for Prevalent Silent Brain Infarction

Chou, Chia Chi; Lien, Li Ming; Chen, Wei Hung; Wu, Mai Szu; Lin, Shiue Ming; Chiu, Hou Chang; Chiou, Hung Yi; Bai, Chyi Huey

doi:10.1161/strokeaha.110.597930

Cited by 29 publications

(36 citation statements)

References 46 publications

(47 reference statements)

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“…In fact, of the studies examined in this review, four of five demonstrate a statistically significance relationship between prevalent SBI and levels of serum creatinine [45], estimated glomerular filtration rate [29] or cystatin C [58]. An association between SBI incidence and serum creatinine (OR: 1.5; 95% CI: 1.00, 2.40) [14] was also suggested.…”

Section: Non-cardiovascular Diseases Diabetes Mellitus and Chronic Kimentioning

confidence: 68%

“…Most remaining published CS studies give estimates in the 10% to 20% range (Table 1). In those undergoing RHS, the range has been greater still, from 5% [29] to 62% [21]. It is clear from these data that a statistically significant correlation exists between mean SBI prevalence and mean sample age, both when all 26 studies providing SBI prevalence data are compiled, and when community and clinic studies are assessed separately (Figures 1, 2 and 3).…”

Section: Resultsmentioning

confidence: 87%

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The epidemiology of silent brain infarction: a systematic review of population-based cohorts

Fanning

Wong

2014

BMC Medicine

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Background: Cerebral infarction is a commonly observed radiological finding in the absence of corresponding, clinical symptomatology, the so-called silent brain infarction (SBI). SBIs are a relatively new consideration as improved imaging has facilitated recognition of their occurrence. However, the true incidence, prevalence and risk factors associated with SBI remain controversial. Methods: Systematic searches of the Medline and EMBASE databases from 1946 to December 2013 were performed to identify original studies of population-based adult cohorts derived from community surveys and routine health screening that reported the incidence and prevalence of magnetic resonance imaging (MRI)-determined SBI. Results: The prevalence of SBI ranges from 5% to 62% with most studies reported in the 10% to 20% range. Longitudinal studies suggest an annual incidence of between 2% and 4%. A strong association was seen to exist between epidemiological estimates of SBI and age of the population assessed. Hypertension, carotid stenosis, chronic kidney disease and metabolic syndrome all showed a strong association with SBI. Heart failure, coronary artery disease, hyperhomocysteinemia and obstructive sleep apnea are also likely of significance. However, any association between SBI and gender, ethnicity, tobacco or alcohol consumption, obesity, dyslipidemia, atrial fibrillation and diabetes mellitus remains unclear. Conclusions: SBI is a remarkably common phenomenon and endemic among older people. This systematic review supports the association of a number of traditional vascular risk factors, but also highlights disparities between clinically apparent and silent strokes, potentially suggesting important differences in pathophysiology and warranting further investigation.

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Section: Non-cardiovascular Diseases Diabetes Mellitus and Chronic Kimentioning

confidence: 68%

Section: Resultsmentioning

confidence: 87%

The epidemiology of silent brain infarction: a systematic review of population-based cohorts

Fanning

Wong

2014

BMC Medicine

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“…32 Several studies have demonstrated that a decreased eGFR is significantly associated with silent (asymptomatic or unreported) brain infarction, as detected by MRI ( Figure 1). [33][34][35] Cystatin C has a stronger association with silent brain infarction than do measures of creatinine or eGFR in individuals aged ≥65 years. 36 Importantly, and further supporting the bi-functional nature of disease interaction, silent brain infarction is an independent prognostic factor for kidney disease progression in patients with CKD.…”

Section: Microvascular Diseasementioning

confidence: 96%

Kidney–brain crosstalk in the acute and chronic setting

et al. 2015

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Patients with kidney disease often exhibit multiple organ dysfunction that is caused, in part, by marked connectivity between the kidney and other organs and tissues. Substantial crosstalk occurs between the kidney and the brain, as indicated by the frequent presentation of neurological disorders, such as cerebrovascular disease, cognitive impairment, and neuropathy during the natural history of chronic kidney disease. The underlying pathophysiology of such comorbid neurological disorders in kidney disease is governed by shared anatomic and vasoregulatory systems and humoral and non-humoral bidirectional pathways that affect both the kidney and the brain. During acute kidney injury, the brain and kidney might interact through the amplification of cytokine-induced damage, extravasation of leukocytes, oxidative stress, and dysregulation of sodium, potassium, and water channels. The advent of dialysis and renal transplantation programmes has led to a reduction in the rate of neurological complications associated with uraemia, but a new set of complications have arisen as a consequence of the effects of dialysis on the central nervous system over the short and long term. This Review discusses the clinical complications of acute and chronic renal failure from a neurologic perspective, and highlights current understanding of the underlying pathophysiologies.

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“…There is evidence that points towards a positive association of chronic kidney disease with stroke [28,29] but some studies have also failed to confirm the association [30,31]. …”

Section: Discussionmentioning

confidence: 99%

Decreased Glomerular Filtration Rate and Markers of Left Atrial Stasis in Patients with Nonvalvular Atrial Fibrillation

Providência¹,

Fernandes²,

Paiva³

et al. 2012

Cardiology

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Background: It is currently unknown if the increased risk of stroke in subjects with chronic kidney disease and atrial fibrillation (AF) is due to the presence of left atrial stasis or to any other vascular or systemic conditions. Methods: This was a retrospective study of 372 subjects undergoing evaluation during an AF episode. The following markers of left atrial stasis were sought on transesophageal echocardiogram: left atrial or left atrial appendage thrombus (LAAT), dense spontaneous echocardiographic contrast (DSEC), and low flow velocities (LFV) in the left atrial appendage. Subgroup comparisons were performed according to the level of estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration equation as follows: ≥90, 45–89.9, and <45 ml/min/1.73 m². Results: LAAT was found in 11.6%, DSEC in 29.0%, and LFV in 14.9% of cases. A significant increase in the prevalence of DSEC was observed in the lower categories of eGFR: 37.8% in eGFR <45 ml/min, 30.7% in eGFR 45–89.9 ml/min, and 17.0% in eGFR ≥90 ml/min (p = 0.009; γ for trend = 0.297, p = 0.002). The same was observed when assessing left atrial abnormality, i.e. the presence of at least one of the former transesophageal echocardiogram changes. On multivariate analysis, clinical parameters from CHADS₂ (congestive heart failure, hypertension, age ≥75, diabetes mellitus and stroke) and CHA₂DS₂-VASc (age 65–74, history of vascular disease, and female gender along with the clinical variables from CHADS₂) were predictors of transesophageal echocardiogram changes and an additive predictive value was found for eGFR. Conclusions: Our results suggest an association between compromised renal function as assessed through eGFR and markers of left atrial stasis in patients with AF. The increased risk of stroke in this population may be due to thromboembolism.

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Adults With Late Stage 3 Chronic Kidney Disease Are at High Risk for Prevalent Silent Brain Infarction

Cited by 29 publications

References 46 publications

The epidemiology of silent brain infarction: a systematic review of population-based cohorts

The epidemiology of silent brain infarction: a systematic review of population-based cohorts

Kidney–brain crosstalk in the acute and chronic setting

Decreased Glomerular Filtration Rate and Markers of Left Atrial Stasis in Patients with Nonvalvular Atrial Fibrillation

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