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Relationship between white matter hyperintensities and chronic kidney disease in patients with acute lacunar stroke

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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 moderate-severe 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.

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Author notes

  1. Lei Yang and Ling Yu contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing, 100020, People’s Republic of China

    Lei Yang, Youqi Kong, Yue Li, Shuna Yang & Wenli Hu

  2. Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No 5. Jingyuan Road, Shijingshan District, Beijing, 100043, People’s Republic of China

    Ling Yu & Shan Gao

  3. Department of Neurology, Affiliated Qianfoshan Hospital of Shandong University, Jinan, China

    Xiaoyu Zhang

  4. Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

    Hua Gu

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  1. Lei Yang
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  2. Ling Yu
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  3. Youqi Kong
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Correspondence to Shan Gao or Wenli Hu.

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The design of this study was approved by the Ethics Committee of Beijing Chao-Yang Hospital, Capital Medical University.

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Yang, L., Yu, L., Kong, Y. et al. Relationship between white matter hyperintensities and chronic kidney disease in patients with acute lacunar stroke. Neurol Sci 41, 3307–3313 (2020). https://doi.org/10.1007/s10072-020-04397-3

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  • DOI: https://doi.org/10.1007/s10072-020-04397-3

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