Large Vessel Disease Modifies the Relationship Between Kidney Injury and Cerebral Small Vessel Disease

Abstract

Background: Recent studies have shown that renal disease is associated with magnetic resonance imaging (MRI) markers of cerebral small vessel disease (CSVD), independent of traditional vascular risk factors. Although large artery lesions might be involved in the cerebrorenal association, evidence has been lacking.Methods: A total of 928 participants from a population-based cohort study were included. Kidney injury measurements included urinary albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). CSVD was assessed on MRI by white matter hyperintensity volume (WMHV), lacunes, brain parenchymal fraction (BPF), cerebral microbleeds (CMBs), and perivascular space. Carotid plaques and brachial-ankle pulse wave velocity (baPWV) were used to assess large artery atherosclerosis and stiffness. Multivariable linear and logistic regression and additional interaction models were used for statistical analysis.Results: Individuals with elevated ACR had higher prevalence of lacunes and more WMHV (p = 0.001 and 0.000, respectively), those with decreased eGFR had smaller brain volume, higher prevalence of lacunes and deep CMBs (p = 0.009, p = 0.017) and p = 0.010 respectively). Interaction analysis revealed that carotid plaque and baPWV significantly enhanced the association between eGFR and BPF (p = 0.001 and p = 0.002, respectively), that is, the association of eGFR with BPF was only significant among participants with carotid plaque and higher baPWV. In addition, carotid plaque enhanced the association between ACR and WMHV (p = 0.034) and baPWV enhanced the association between ACR and the presence of lacunes (p = 0.027). Modifying effect of large vessel disease markers on the association between kidney injury measurements and CMBs was not significant.Conclusion: Evaluation of subclinical CVSD in individuals with kidney injury is warranted, especially in those with combined large artery disease.

Transcranial Doppler assessment of patients with cerebral small vessel disease

“…These results are in agreement with study published in 2018 by Ao et al who included 928 participants and found a relation between large artery atherosclerosis and cerebral SVD [14]. Another study done by Nam and his Because cerebral SVD is diffuse and affects the small arteries, arterioles, capillaries and venules, the impairment of cerebral and extracerebral [19] autoregulation is global [20].…”

Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta‐Analysis

“…Abstract screening and exclusion of nonoriginal research, records lacking full text, or records that did not quantitatively assess a relationship between arterial stiffness and cSVD resulted in 82 publications for systematic review. Of the 82 articles, 12 assessed recent small subcortical infarcts, 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 24 assessed the presence of lacunes, 21 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 9 assessed enlarged perivascular spaces, 118 , 138 , 144 , 145 , 150 , 152 , 153 , 154 , 155 23 assessed cerebral microbleeds, 37 , 118 , 120 , …”

“…The majority of studies included in the systematic review were cross‐sectional in nature; with 86% of the cross‐sectional studies reporting a significant association between arterial stiffness and cSVD. 21 , 118 , 119 , 120 , 121 , 123 , 124 , 125 , 126 , 127 , 128 , 130 , 131 , 132 , 133 , 134 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 147 , 148 , 150 , 151 , 152 , 153 , 154 , 156 , 157 , 158 , 160 , 161 , 163 , 165 , 166 , 167 , 169 , 171 , 172 , 173 , 176 , 177 , 178 , 179 , 182 ,…”

“… 21 , 118 , 119 , 120 , 121 , 123 , 124 , 125 , 126 , 127 , 128 , 130 , 131 , 132 , 133 , 134 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 147 , 148 , 150 , 151 , 152 , 153 , 154 , 156 , 157 , 158 , 160 , 161 , 163 , 165 , 166 , 167 , 169 , 171 , 172 , 173 , 176 , 177 , 178 , 179 , 182 , 183 , 185 , 186 …”

Prolonged lifespan in a spontaneously hypertensive rat (stroke prone) model following intravenous infusion of mesenchymal stem cells

“…Here, we also observed preserved renal function in MSC-infused animals. Due to low vascular resistance in the kidney, the arterioles are highly susceptible to the endothelial injury of small vessels [ 36 , 37 ], which is often associated with a high prevalence of chronic kidney disease and poor prognosis among the elderly population [ 36 , 38 , 39 , 40 ]. In this study, the concentrations of serum BUN and Cre were elevated in the vehicle-infused group compared to those in the control group, which was also observed in other previous studies [ 41 , 42 ].…”