Kidney function and white matter disease in young stroke patients: analysis of the stroke in young fabry patients study population.
OBJECTIVE
Impaired kidney function is thought to be associated with small vessel disease, outcome, and mortality in the general stroke population. Data are limited regarding young patients. The aim of this study was to investigate the association of kidney function and white matter hyperintensities (WMHs) in young patients with first ischemic stroke.


METHODS
We analyzed 2500 young (18-55 years) patients with first-ever ischemic stroke from the prospective observational Stroke in Young Fabry Patients (SIFAP1) study with available MRI data on WMH. Of these, 2009 had available data concerning estimated glomerular filtration rate (eGFR). Kidney function was expressed as eGFR by the Modification of Diet in Renal Disease method. Deep WMHs on MRI were classified by the Fazekas score. Multivariate analysis was performed using a regression model with random effects.


RESULTS
Mean eGFR was 96.7 mL/min in those with WMH Grade 0 to 1 (none to mild), 90.7 mL/min in WMH Grade 2 (moderate), and 89 mL/min in WMH Grade 3 (severe). Univariate analysis revealed WMH to be associated with age (P<0.001), hypertension (P<0.001), cardiovascular disease (P=0.015), overweight (body mass index >25 kg/m(2); P=0.013), current smoking (P=0.044), and eGFR (P=0.009). In multivariate analysis, age, hypertension, and eGFR remained associated with WMH severity.


CONCLUSIONS
In young patients with acute ischemic stroke, lower eGFR values in the normal range are associated with the presence of moderate to severe WMH.  Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique Identifier: NCT00414583.
Department of Neurology and Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. robert.steinicke@charite.de
Robert
R
Steinicke
Beate
B
Gaertner
Ulrike
U
Grittner
Wolf
W
Schmidt
Martin
M
Dichgans
Peter U
PU
Heuschmann
Christian
C
Tanislav
Jukka
J
Putaala
Manfred
M
Kaps
Matthias
M
Endres
Reinhold
R
Schmidt
Franz
F
Fazekas
Bo
B
Norrving
Arndt
A
Rolfs
Peter
P
Martus
Turgut
T
Tatlisumak
Christian
C
Enzinger
Gerhard Jan
GJ
Jungehulsing
D000293:Adolescent; D000328:Adult; D001927:Brain Diseases / Q000209:etiology / Q000503:physiopathology*; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D014652:Vascular Diseases / Q000473:pathology; D055815:Young Adult