Association Between White Matter Hyperintensities and Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Wei, Chenchen; Yan, Changxin; Yu, Xihe; Wang, Lin; Zhang, Rui; Jiang, Jiajia; Dai, Qi; Li, Junrong; Chen, Xue Mei

doi:10.3389/fmed.2022.770184

Cited by 8 publications

(2 citation statements)

References 54 publications

(39 reference statements)

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“…Pre-treatment morbidity includes cerebrovascular changes, atherosclerosis and hypertension. [18][19][20] Posttreatment complications include a higher risk of hemorrhage and higher all-cause mortality. 1,17 The kidney and the brain have been hypothesized to share a common pattern of microvascular impairment resulting from cardiovascular risk factors, due to their shared status as high-flow end organs with autoregulatory mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Kidney dysfunction predicts 90 days mortality after stroke thrombectomy independent of cardiovascular risk factors and chronic kidney disease

Heinze,

Schell,

Nägele

et al. 2024

European Stroke Journal

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Introduction: Kidney dysfunction (KD) is a risk factor for cerebrovascular events and has been shown to have a detrimental effect on outcome after stroke. We evaluated the influence of KD at admission and pre-existing diagnosis of chronic kidney disease (CKD) before thrombectomy for anterior circulation stroke on functional independence and mortality 90 days after stroke in this cross-sectional study. Patients and methods: We included patients with acute ischemic stroke in the anterior circulation treated with thrombectomy at our hospital between June 2015 and May 2022. We analyzed clinical characteristics, laboratory values and pre-existing diagnosis of CKD. KD at admission was defined as glomerular filtration rate (GFR) <60 ml/min/1.73 m2. Outcomes were defined as a modified Rankin Scale Score of 0-2 for functional independence and mortality at 90 days. We fitted multivariate regression analysis to examine the influence of pre-treatment KD and pre-diagnosed CKD on outcome. Results: Nine hundred fifty-three patients were included in this analysis (mean age 73.8 years, 54.2% female). KD was present in 31.8%, and patients with KD were older and more often female, presented more often with comorbidities such as arterial hypertension, diabetes, and atrial fibrillation, and were less often independent before the index stroke. In multivariate analysis adjusted for age, independence before the index stroke, diabetes, hypertension, atrial fibrillation, initial NIHSS, thrombolysis treatment, and recanalization outcome, KD on admission had no significant influence on functional independence 90 days after stroke, but predicted mortality with an odds ratio of 1.80 (95% CI 1.23–2.63, p = 0.003). This influence also persisted when controlling for pre-diagnosed CKD (OR 1.60, 95% CI 1.05–2.43, p = 0.027). Discussion: KD might function as a surrogate parameter for comorbidity burden and thus increased risk of mortality in this cohort. Conclusions: KD on admission is associated with an 80% higher risk of mortality at 90 days after stroke thrombectomy independent of cardiovascular risk factors and CKD awareness. KD on admission should not exclude patients from thrombectomy but might support prognostic evaluation.

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Section: Discussionmentioning

confidence: 99%

Kidney dysfunction predicts 90 days mortality after stroke thrombectomy independent of cardiovascular risk factors and chronic kidney disease

Heinze,

Schell,

Nägele

et al. 2024

European Stroke Journal

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“…Linked to cerebral small vessel disease, WMHs have been associated with an increased risk of cognitive dysfunction and all-cause dementia [ 31 ], probably by disrupting the connections between the cortex and the subcortical nuclei [ 32 , 33 ] or contributing to the accumulation of amyloid-β proteins [ 34 ]. On the other hand, the relationship between GFR and concluded that CKD is associated with poorer WMHs [ 25 , 35 , 36 ], with mechanisms related to cerebrovascular disease, systemic inflammation, cerebral hypoperfusion, oxidative stress, disturbances of small blood vessels, breakdown of the blood-brain barrier, glial activation, loss of oligodendrocytes, and demyelination caused by chronic diffuse hypoperfusion [ 37–39 ].…”

Section: Discussionmentioning

confidence: 99%

Cerebral white matter burden is linked to cognitive function in patients undergoing hemodialysis

Wu,

Lin

et al. 2024

Annals of Medicine

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Introduction Chronic kidney disease is related to neurodegeneration and structural changes in the brain which might lead to cognitive decline. The Fazekas scale used for assessing white matter hyperintensities (WMHs) was associated with poor cognitive performance. Therefore, this study investigated the associations between the mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), cognitive abilities screening instrument (CASI), and Fazekas scale in patients under hemodialysis (HD). Methods The periventricular (PV) WMHs and deep WMHs (DWMHs) in brain magnetic resonance images of 59 patients under dialysis were graded using the Fazekas scale. Three cognition function tests were also performed, then multivariable ordinal regression and logistic regression were used to identify the associations between cognitive performance and the Fazekas scale. Results There were inverse associations between the three cognitive function tests across the Fazekas scale of PVWMHs ( p = .037, .006, and .008 for MMSE, MoCA, and CASI, respectively), but the associations were attenuated in the DWMHs group. In CASI, significant differences were identified in short-term memory, mental manipulation, abstract thinking, language, spatial construction, and name fluency in the PVWMHs group. However, DWMHs were only significantly correlated with abstract thinking and short-term memory. Conclusion An inverse correlation existed between the Fazekas scale, predominantly in PVWMHs, and cognition in patients undergoing HD. The PVWMHs were associated with cognitive performance assessed by MMSE, MoCA, and CASI, as well as with subdomains of CASI such as memory, language and name fluency in patients undergoing HD.

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Cognitive impairment in patients awaiting kidney and liver transplantation—A clinically relevant problem?

Golenia,

Olejnik,

Grusiecka‐Stańczyk

et al. 2024

Brain and Behavior

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IntroductionCognitive impairment (CI) is common in both end‐stage kidney disease (ESKD) and alcohol‐related liver cirrhosis. The aim of this study was to assess the prevalence and patterns of CI in patients awaiting kidney and liver transplantation, and to identify its determinants.MethodsIn this cross‐sectional, prospective study, 31 consecutive patients with ESKD and 31 consecutive patients with alcohol‐related liver cirrhosis, all currently on transplant waiting lists, were screened for cognitive decline using the Addenbrooke's Cognitive Examination. Medical history, demographics, and laboratory test results were also collected.ResultsThe prevalence of CI among patients with ESKD and alcohol‐related liver cirrhosis was 26% and 90%, respectively. In both groups, memory was the most affected cognitive domain, along with verbal fluency in patients with ESKD, and visuospatial abilities in patients with alcoholic cirrhosis. The most statistically significant increase in the prevalence of CI was found in patients with lower educational attainment, in both alcohol‐related liver cirrhosis and ESKD populations as well as in older patients with alcoholic cirrhosis. Furthermore, better cognitive functioning in ESKD patients was associated with higher levels of total lymphocyte count and alanine transaminase (ALT), and in alcohol‐related liver cirrhosis patients with higher levels of ALT and aspartate transaminase. A nonsignificant trend toward lower memory domain scores was also observed with increasing ammonia levels and increasing severity of liver disease (higher Child–Pugh scores). Finally, suboptimal performance on the screening test was correlated with the severity of liver disease as assessed by the Model for End‐Stage Liver Disease Sodium (MELD‐Na), but not at the statistically significant level.ConclusionsThe prevalence of CI, especially in patients with alcohol‐related liver cirrhosis, is high and can be a significant clinical problem, negatively affecting the transplantation process. Routine screening tests in this group would contribute to the implementation of appropriate management, such as rehabilitation program or psychosocial treatments and facilitate the provision of specialized health care.

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Association Between White Matter Hyperintensities and Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 54 publications

Kidney dysfunction predicts 90 days mortality after stroke thrombectomy independent of cardiovascular risk factors and chronic kidney disease

Kidney dysfunction predicts 90 days mortality after stroke thrombectomy independent of cardiovascular risk factors and chronic kidney disease

Cerebral white matter burden is linked to cognitive function in patients undergoing hemodialysis

Cognitive impairment in patients awaiting kidney and liver transplantation—A clinically relevant problem?

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