Asymptomatic cerebral lacunae in patients with chronic kidney disease.
BACKGROUND
It remains unknown whether the prevalence of silent lacunar infarcts increases as renal function declines or what factors known as atherosclerotic risk factors are related to the development of lacunar infarcts.


METHODS
Fifty-one patients with chronic kidney disease without diabetes mellitus and 80 patients with essential hypertension with normal renal function were included in the study. The existence of lacunar infarcts was evaluated on brain magnetic resonance imaging scans. We evaluated the severity of carotid atherosclerosis by means of intima-media thickness of 1.0 mm or greater height in bilateral carotid arteries and by affecting factors, including plasma homocysteine levels.


RESULTS
Lacunae prevalence was 25% in patients with a creatinine clearance (Ccr) greater than 40 mL/min/1.73 m2, 85% in patients with a Ccr less than 40 mL/min/1.73 m2, and 29% in patients with essential hypertension with normal renal function. Patients with lacunae had significantly lower hematocrits associated with increased fibrinogen and lipoprotein(a) levels compared with those without lacunae. Plasma total homocysteine and insulin levels at 2 hours after a 75-g glucose tolerance test correlated significantly with lacunae. Ischemic heart changes shown by electrocardiogram and thickened carotid intima-media thickness were significantly more frequent in patients with lacunae. However, logistic regression analysis showed that the most strongly contributing factor for lacunar infarcts was decline in Ccr (confidence interval, 0.933 to 0.995; P < 0.05).


CONCLUSIONS
Decreased renal function, even without diabetes mellitus, is a risk factor for silent lacunar infarcts.
Kobayashi
Shuzo
S
Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan. shuzo@shonankamakura.or.jp
Ikeda
Toshio
T
Moriya
Hidekazu
H
Ohtake
Takayasu
T
Kumagai
Hiromichi
H
D000740:Anemia / Q000453:epidemiology; D020520:Brain Infarction / Q000175:diagnosis / Q000453:epidemiology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006400:Hematocrit; D006710:Homocysteine / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D007674:Kidney Diseases / Q000453:epidemiology*; D007677:Kidney Function Tests; D017270:Lipoprotein(a) / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D014463:Ultrasonography
D007328:Insulin; D017270:Lipoprotein(a); D006710:Homocysteine; D005340:Fibrinogen; D003404:Creatinine