title: Kidney function and cerebral small vessel disease in the general population.
abstract: BACKGROUND
  Anatomic and hemodynamic similarities between renal and cerebral vessels suggest a tight link between kidney disease and brain disease. Although several distinct markers are used to identify subclinical kidney and brain disease, a comprehensive assessment of how these markers link damage at both end organs is lacking.
  
  
  OBJECTIVE
  To investigate whether measures of kidney function were associated with cerebral small vessel disease on MRI.
  
  
  METHODS
  In 2526 participants of the population-based Rotterdam Study, we measured urinary albumin-to-creatinine ratio, and estimated glomerular filtration rate based on serum creatinine and cystatin C. All participants underwent brain magnetic resonance imaging. We assessed presence of cerebral small vessel disease by calculating white matter lesion volumes and rating the presence of lacunes and cerebral microbleeds. We used multivariable linear and logistic regression to investigate the association between kidney function and cerebral small vessel disease.
  
  
  RESULTS
  Worse kidney function was consistently associated with a larger white matter lesion volume (mean difference per standard deviation increase in albumin-to-creatinine ratio: 0.09, 95% confidence interval 0.05; 0.12; per standard deviation decrease in creatinine-based estimated glomerular filtration rate: -0.04, 95% confidence interval -0.08;-0.01, and per standard deviation decrease in cystatin C-based estimated glomerular filtration rate: -0.09, 95% confidence interval -0.13;-0.05). Persons with higher albumin-to-creatinine ratio or lower cystatin C-based estimated glomerular filtration rate levels had a higher prevalence of lacunes (odds ratio per standard deviation increase in albumin-to-creatinine ratio: 1.24, 95% confidence interval 1.07; 1.43). Only participants in the highest quartile of albumin-to-creatinine ratio had a higher frequency of microbleeds compared to the lowest quartile.
  
  
  CONCLUSIONS
  Worse kidney function is associated with cerebral small vessel disease. Of all measures of kidney function, in particular albumin-to-creatinine ratio is related to cerebral small vessel disease.
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Saloua
authors.initials: S
authors.lastname: Akoudad
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Sanaz
authors.initials: S
authors.lastname: Sedaghat
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.affiliation: Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Meike W
authors.initials: MW
authors.lastname: Vernooij
mesh_terms: D000419:Albuminuria / Q000652:urine*; D001921:Brain / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000097:blood / Q000473:pathology / Q000652:urine; D059345:Cerebral Small Vessel Diseases / Q000097:blood* / Q000473:pathology / Q000652:urine*; D003404:Creatinine / Q000097:blood* / Q000652:urine*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D059409:Stroke, Lacunar / Q000097:blood / Q000473:pathology / Q000652:urine; D066127:White Matter / Q000473:pathology
chemical_list: D055316:Cystatin C; D003404:Creatinine
keywords: albumin-to-creatinine ratio; cerebral small vessel disease; creatinine; cystatin C; kidney function