title: Cerebral white matter hyperintensity predicts cardiovascular events in haemodialysis patients.
abstract: OBJECTIVE
  Cerebral white matter hyperintensities (WMHs), comprised of periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DSWMH), have been presumed to be predictors for future stroke, cognitive impairment and dementia in the general population. However, no longitudinal studies have been performed to determine the clinical significance of WMHs in haemodialysis (HD) patients. In the present study, we investigated the influence of WMHs as a predictor of future cardiovascular disease in HD patients.
  
  
  METHODS
  Cranial magnetic resonance imaging was performed on 179 HD patients with no past history of stroke from April 2006 to October 2009, and the prevalence of WMHs was investigated. The patients were followed prospectively until March 2012 or death or renal transplantation. The influence of WMHs on cardiovascular events was investigated using the Kaplan-Meier method and Cox proportional hazards analysis.
  
  
  RESULTS
  The patients with advanced PVH and DSWMH had a significantly higher incidence of cardiovascular morbidity than those without advanced PVH and DSWMH by Kaplan-Meier analysis. By multivariate Cox proportional hazards analysis, the presence of advanced PVH and DSWMH increased the risk of cardiovascular events, independent of other cardiovascular risk factors. In addition, the present study revealed that of the subtypes of WMHs, PVH was a stronger predictor of cardiovascular events compared to DSWMH.
  
  
  CONCLUSIONS
  The present study indicates that the presence of WMHs is a novel predictor of cardiovascular events in HD patients, and that PVH is more closely associated with incident cardiovascular disease.
authors.affiliation: Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Naganuma
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Takemoto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shima
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishimura
authors.forename: Mikio
authors.initials: M
authors.lastname: Okamura
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakatani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation; D056784:Leukoencephalopathies / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: cardiovascular disease; dialysis; longitudinal study; periventricular hyperintensity; stroke; subcortical white matter hyperintensity; white matter hyperintensities