Charlotte Robinson

DocwireNews

Cerebral small vessel disease (CSVD) and chronic kidney disease (CKD) share several risk factors, including hypertension, which is likely the most common treatable risk factor for both. Previous studies examining the relationship between the two diseases have shown mixed results. So, Tomas M&aring;nsson and others explored the association between CSVD and CKD as well as the potential role of hypertension in this association. Their results appeared in BMC Nephrology.CSVD includes pathologies of the small vessels of the brain, which can be identified and diagnosed by magnetic resonance imaging (MRI). Its prevalence increases with age, and it is common in the older population; this is also true of CKD. Some previous findings have suggested a possible association between CSVD and CKD. Both have been linked to processing speed impairment, although processing speed and executive function appear to be more affected by CSVD. Both the kidney and the brain are likely sensible to hypertension since they share similar low vascular resistance mechanisms. Moreover, CKD is related to other vascular diseases, such as intermittent claudication and myocardial infarction.Data for the M&aring;nsson study originated from the ongoing population-based cohort study Good Aging in Sk&aring;ne (G&Aring;S), conducted at the Department of Geriatric Medicine, Sk&aring;ne University Hospital, in Malm&ouml;, Sweden. Participants aged &ge;60 years have been recruited randomly from the population register since 2001, and they are invited to undergo examination every 3 to 6 years until death, depending on their age. A subgroup of 407 patients had an MRI examination between March 2016 and March 2018. Of these patients, 390 were included in the study; 214 (54.9%) were female, and mean age was 75.4 years (SD 3.6).CKD was defined as estimated glomerular filtration rate (eGFR) &lt;60 mL/min/1.73 m2. A physician determined a history of hypertension based on medical history and medical record for an International Statistical Classification of Diseases, Tenth Revision, diagnosis of primary or secondary hypertension. The researchers used binary logistic regression models to examine associations between CKD and the presence of white matter hyperintensities (WMHs), lacunar infarcts, cerebral microbleeds (CMBs), cortical atrophy, composite CSVD, and modified standards for reporting vascular changes on neuroimaging (STRIVE, as presented by <a href="https://www.doi.org/10.1016/S1474-4422(13)70124-8" target="_blank" rel="noopener">Wardlaw et al</a> in 2013). In a secondary analysis, the researchers performed the same calculations but stratified the study sample based on hypertension status.All markers of CSVD were more prevalent in the CKD group versus the group with normal kidney function (eGFR &ge;60 mL/min/1.73 m2). In comparison with patients with normal kidney function, those with CKD had greater prevalence of WMHs (39.4% vs 28.0%), lacunar infarcts (10.6% vs 7.4%), CMBs (36.2% vs 24.7%), and cortical atrophy (59.6% vs 47.6%). The group with CKD more often met the criteria for CSVD according to the composite CSVD and modified STRIVE variables compared with participants with normal kidney function (61.7% vs 47.3% and 85.1% vs 77.4%, respectively). In the stratified analyses, there was no observed association between CKD and CSVD in nonhypertensive patients. In the hypertensive group, CKD was associated with CMBs (odds ratio [OR], 1.93; CI, 1.04-3.59; P=.037) and cortical atrophy (OR, 2.45; CI, 1.34-4.48; P=.004), after adjusting for age and sex.The researchers recognized several limitations of their study. They used a modified version of the SVD score (composite CSVD) and a modified version of STRIVE, which might have limited the comparability of findings against other studies. The small prevalence of some lesions could have prevented observation of associations between CSVD and CKD due to lack of power. Blood samples were not collected at the MRI examination, so it is unclear whether CKD appeared before or after the MRI examination. The study was exploratory, and more research is required to determine the relationship among CKD, CSVD, and hypertension.In summary, the study authors wrote, &ldquo;We observed an association between CKD and markers of CSVD (CMBs and cortical atrophy) in the general older hypertensive population. In the general older nonhypertensive population, no associations between CKD and any markers of CSVD were observed. Our findings might indicate that hypertension is a link between CKD and CSVD. Further studies investigating the relationship between CKD, CSVD, and hypertension are warranted.&rdquo;Source: <a href="https://doi.org/10.1186/s12882-024-03528-8" target="_blank" rel="noopener">BMC Nephrology</a>

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Association of CSVD, CKD, Hypertension

Chronic Kidney Disease

Researchers explored the association between cerebral small vessel disease (CSVD) and chronic kidney disease (CKD) plus the potential role of hypertension in this association. 

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