Association of kidney dysfunction with silent lacunar infarcts and white matter hyperintensity in the general population: the Ohasama study.
BACKGROUND
No previous study has investigated the association of kidney dysfunction with silent lacunar infarcts and white-matter hyperintensity (WMH) independent of ambulatory blood pressure (BP).


METHODS
A cross-sectional study involving 1,008 participants (mean age 66 years) from a general population of Ohasama, Japan, was conducted. Calculated creatinine clearance (CCr) was estimated using the Cockcroft-Gault equation. In continuous and categorical analyses, the association between CCr and the prevalence of silent lacunar infarcts and WMH was investigated. Silent lacunar infarcts and WMH were detected on MRI. Multiple logistic regression analysis adjusted for 24-hour ambulatory BP, sex, age, body mass index, smoking and drinking status, antihypertensive medication, and histories of hypercholesterolemia, diabetes mellitus and heart disease was performed.


RESULTS
On univariate analysis, decreased CCr (continuous variable) and CCr <60 ml/min/1.73 m(2) (categorical variable) were significantly associated with lacunar infarcts and WMH. After adjustment, each 1-standard-deviation decrease in CCr (odds ratio = 1.22; p = 0.036) and CCr <60 ml/min/1.73 m(2) (odds ratio = 1.68; p = 0.007) was significantly associated with a high prevalence of lacunar infarcts. Even when 24-hour ambulatory BP was within the normal range (<130/80 mm Hg), CCr <60 ml/min/1.73 m(2) was associated with a high prevalence of lacunar infarcts (odds ratio = 1.62; p = 0.047). CCr <60 ml/min/1.73 m(2) and 24-hour ambulatory BP had additive effects on lacunar infarcts. After the same adjustment, the association between CCr and WMH was not significant.


CONCLUSIONS
CCr is closely associated with lacunar infarcts, suggesting that kidney dysfunction in the elderly is an independent risk factor or predictor for silent lacunar infarcts.
Otani
Harunori
H
Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan.
Kikuya
Masahiro
M
Hara
Azusa
A
Terata
Shiho
S
Ohkubo
Takayoshi
T
Kondo
Takeo
T
Hirose
Takuo
T
Obara
Taku
T
Metoki
Hirohito
H
Inoue
Ryusuke
R
Asayama
Kei
K
Kanno
Atsuhiro
A
Terawaki
Hiroyuki
H
Nakayama
Masaaki
M
Totsune
Kazuhito
K
Hoshi
Haruhisa
H
Satoh
Hiroshi
H
Izumi
Shin-Ichi
S
Imai
Yutaka
Y
D000367:Age Factors; D000368:Aged; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D001921:Brain / Q000473:pathology*; D020520:Brain Infarction / Q000208:ethnology / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors
D015415:Biomarkers; D003404:Creatinine