Relationship between silent brain infarction and chronic kidney disease.
BACKGROUND
The presence of silent brain infarction (SBI) increases the risk of symptomatic stroke and dementia. The association between SBI and chronic kidney disease (CKD) has not been clarified. Moreover, little is known about what factors are related to SBI in CKD patients and whether the prevalence of SBI differs in CKD stage or cause of CKD.


METHODS
This is a cross-sectional study. A total of 375 subjects-335 with CKD and 40 with essential hypertension-were included. All subjects underwent magnetic resonance imaging (MRI) of the brain to detect SBI. Glomerular filtration rate (GFR) was estimated using Modification of Diet in Renal Disease equation, and cardiovascular risk factors were examined.


RESULTS
The prevalence of SBI was 56.5% in all subjects. Among causes of CKD, hypertensive nephrosclerosis had a strong association with SBI. According to the estimated GFR (eGFR) stage, the more severe the stage of eGFR, the higher the prevalence of SBI (age-adjusted odds ratio [95% confidence interval] for eGFR 30-59, 15-29 and <15 versus >or=60 mL/min/1.73 m(2): 1.34 [0.68-1.99], 1.94 [1.30-2.57] and 2.51 [1.91-3.10]). In multivariate logistic analysis, eGFR was related to SBI independently, in addition to age and blood pressure (P = 0.025). However, other traditional and non-traditional risk factors were not.


CONCLUSIONS
There was an independent association between eGFR and SBI. CKD patients should receive active detection of SBI and more intensive preventive management, especially for hypertension, should be needed in CKD patients to prevent SBI.
Kobayashi
Mayumi
M
Department of Medical Science, Division of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama City University Graduate School of Medicine and School of Medicine, Yokohama, Japan.
Hirawa
Nobuhito
N
Yatsu
Keisuke
K
Kobayashi
Yusuke
Y
Yamamoto
Yuichiro
Y
Saka
Sanae
S
Andoh
Daisaku
D
Toya
Yoshiyuki
Y
Yasuda
Gen
G
Umemura
Satoshi
S
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D002544:Cerebral Infarction / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000145:classification / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors
D000959:Antihypertensive Agents