title: Cerebral small vessel disease and kidney function predict long-term survival in patients with acute stroke.
abstract: OBJECTIVE
  Cerebral small vessel disease reflected by white matter lesions (WMLs) in MRI and kidney function reflected by estimated glomerular filtration rate (eGFR) is closely associated in patients without stroke. We studied whether eGFR and WMLs predict long-term survival in patients with acute stroke.
  
  
  METHODS
  After exclusion of patients with low eGFR (N=5 [1.3%]; <30 mL/min/1.73 m(2)), consecutive patients with acute stroke (N=378) subjected to MRI and serum creatinine determination were included in the study and prospectively followed-up up to 12 years.
  
  
  RESULTS
  Of the patients, 71.2% had died during the follow-up, 152 (40.2%) had moderate (eGFR <60 mL/min/1.73 m(2)), and 226 (59.8%) had normal or mildly impaired eGFR (>or=60 mL/min/1.73 m(2)). Of the patients, 108 (28.6%) had mild, 68 (18.0%) had moderate, and 202 (53.4%) had severe WMLs. In logistic regression analysis adjusted with age and sex, eGFR <60 mL/min/1.73 m(2) was associated with severe WMLs (relative risk 2.77, 95% CI 1.10 to 6.98, P=0.030). In Cox regression survival analysis adjusted with significant covariates, eGFR <60 mL/min/1.73 m(2) (1.30, 95% CI 1.00 to 1.68, P=0.047) and severe WMLs (hazard ratio 1.32, 95% CI 1.02 to 1.71, P=0.033) were associated with poor survival, whereas they were not independent from each other. In further analyses, presence of either eGFR >or=60 mL/min/1.73 m(2) or only mild to moderate WMLs, or both, was associated with improved survival compared with all other combinations.
  
  
  CONCLUSIONS
  Cerebral small vessel disease is closely associated with kidney function in patients with acute stroke. Cerebral small vessel disease and kidney function are closely associated predictors of poor poststroke survival.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland. nikuoksala@gmail.com
authors.forename: Niku K J
authors.initials: NK
authors.lastname: Oksala
authors.forename: Tapani
authors.initials: T
authors.lastname: Salonen
authors.forename: Timo
authors.initials: T
authors.lastname: Strandberg
authors.forename: Anni
authors.initials: A
authors.lastname: Oksala
authors.forename: Tarja
authors.initials: T
authors.lastname: Pohjasvaara
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Pekka J
authors.initials: PJ
authors.lastname: Karhunen
authors.forename: Timo
authors.initials: T
authors.lastname: Erkinjuntti
mesh_terms: D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000473:pathology* / Q000503:physiopathology*; D013534:Survival; D016896:Treatment Outcome
chemical_list: D003404:Creatinine