title: Chronic Kidney Disease in Patients With Lacunar Stroke: Association With Enlarged Perivascular Spaces and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease.
abstract: OBJECTIVE
  The relationship between chronic kidney disease and cerebral small vessel disease (cSVD), especially enlarged perivascular spaces (EPVS), has not been fully understood. This study aimed to investigate the association of chronic kidney disease and EPVS, as well as the total burden of cSVD on magnetic resonance imaging, expressed by the simultaneous presence of multiple markers of cSVD, among patients with first-ever lacunar stroke.
  
  
  METHODS
  Four hundred and thirteen consecutive patients were prospectively enrolled. Centrum semiovale and basal ganglia EPVS on T2-weighted magnetic resonance imaging, as well as other imaging markers of cSVD, including lacune, white matter lesions, and cerebral microbleeds, were rated using validated scales. Chronic kidney disease was defined as either reduced estimated glomerular filtration rate or the presence of proteinuria.
  
  
  RESULTS
  After adjustments for potential confounders by logistic regression, proteinuria and impaired estimated glomerular filtration rate were correlated with the severity of EPVS in both centrum semiovale (odds ratio [OR] 2.59; 95% confidence interval [CI] 1.19-5.64 and OR 2.37; 95% CI 1.19-4.73) and basal ganglia (OR 5.12; 95% CI 2.70-12.10 and OR 4.17; 95% CI 2.08-8.37). A similar association was also found between proteinuria and low estimated glomerular filtration rate levels and the comprehensive cSVD burden (OR 2.13; 95% CI 1.10-4.14 and OR 5.59; 95% CI 2.58-12.08).
  
  
  CONCLUSIONS
  Proteinuria and impaired estimated glomerular filtration rate are associated with increasing EPVS severity and, furthermore, accumulated magnetic resonance imaging burden of cSVD in patients with first-ever acute lacunar stroke.
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Lulu
authors.initials: L
authors.lastname: Xiao
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Wenya
authors.initials: W
authors.lastname: Lan
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Wen
authors.initials: W
authors.lastname: Sun
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Qiliang
authors.initials: Q
authors.lastname: Dai
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Yunyun
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Ping
authors.initials: P
authors.lastname: Zheng
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Wenping
authors.initials: W
authors.lastname: Fan
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Nan
authors.initials: N
authors.lastname: Ma
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Zhiliang
authors.initials: Z
authors.lastname: Guo
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Xin
authors.initials: X
authors.lastname: Chen
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Xia
authors.initials: X
authors.lastname: Xie
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Lili
authors.initials: L
authors.lastname: Xu
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.). zwsemail@sina.com xfliu2@vip.163.com.
authors.forename: Wusheng
authors.initials: W
authors.lastname: Zhu
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.).
authors.forename: Gelin
authors.initials: G
authors.lastname: Xu
authors.affiliation: From the Department of Neurology (L.X., W.S., Q.D., Y.X., W.F., N.M., Z.G., X.C., X.X., L.X., W.Z., G.X., X.L.), Department of Radiology (L.L.), and National Clinical Research Center of Kidney Diseases (Y.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China (W.L.); and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (P.Z.). zwsemail@sina.com xfliu2@vip.163.com.
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Liu
mesh_terms: D000368:Aged; D001479:Basal Ganglia / Q000378:metabolism / Q000473:pathology*; D059345:Cerebral Small Vessel Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism; D059409:Stroke, Lacunar / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism
keywords: cerebral small vessel disease; enlarged perivascular spaces; glomerular filtration rate; proteinuria