Relationship between white matter hyperintensities and chronic kidney disease in patients with acute lacunar stroke
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ORIGINAL ARTICLE
Relationship between white matter hyperintensities and chronic kidney disease in patients with acute lacunar stroke Lei Yang 1 & Ling Yu 2 & Youqi Kong 1 & Xiaoyu Zhang 3 & Yue Li 1 & Shuna Yang 1 & Hua Gu 4 & Shan Gao 2 & Wenli Hu 1 Received: 15 November 2019 / Accepted: 4 April 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background and purpose Previous studies have revealed a relationship between chronic kidney disease (CKD) and white matter hyperintensities (WMH). However, studies on the WMH and CKD in acute stroke patients are rare, and the conclusion is consistent. Our study aimed to investigate the relationship between the severity of WMH and CKD in acute lacunar infarction patients. Methods Consecutive acute lacunar infarction patients were recruited in this cross-sectional study. All patients were divided into two groups according to the severity of periventricular WMH (PVWMH) and deep WMH (DWMH). We dichotomized the severity of WMH (PVWMH and DWMH, separately) into mild group (Fazekas scores 0–1) and moderate-severe group (Fazekas scores 2–3). Estimated glomerular filtration rate (eGFR), proteinuria, vascular risk factors, and clinical features were compared between these two groups. Multivariable logistic regression analysis was used to investigate the association between the severity of WMH and risk factors. Results A total of 993 acute lacunar infarction patients aged 25–95 years were enrolled. The proportions of participants presenting moderate-severe group PVWMH and DWMH were 46.6% and 38.6%, respectively. Patients with moderate-severe PVWMH had higher age (P < 0.001) and higher incidence of stroke history (P < 0.001) than those in mild group. The level of serum creatinine and the presence of CKD were significantly higher while the eGFR was significantly lower in patients with moderatesevere PVWMH than those with mild PVWMH. Patients with moderate-severe DWMH (n = 383) also had higher age (P < 0.001) and often had a history of stroke (P < 0.001). But the association between the severity of DWMH and eGFR was not found. Multivariable logistic regression analyses showed stage 2 CKD and stage 3 CKD were independently associated with moderate-severe PVWMH, but not DWMH. Conclusions Our study demonstrates that CKD was independently associated with moderate-severe PVWMH in patients with acute lacunar infarction, but not DWMH. PVWMH and DWMH may have distinct pathophysiology. Keywords Chronic kidney disease . Estimated glomerular filtration rate . Lacunar infarction . White matter hyperintensities (WMH)
Lei Yang and Ling Yu contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10072-020-04397-3) contains supplementary material, which is available to authorized users. * Shan Gao [email protected] * Wenli Hu [email protected] 1
Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, People’s Republic of China
2
Department of End
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