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Front. Neurol. | doi: 10.3389/fneur.2018.00284

Association of Chronic Kidney Disease with Small Vessel Disease in Patients with Hypertensive Intracerebral Hemorrhage

 Yuan-Hsiung Tsai1, 2*, Meng Lee2, 3, Ming-Hsueh Lee2, 4, Leng-Chieh Lin5, Sheng-Wei Chang1, 2, Hsu-Huei Weng1, 2, Jen-Tsung Yang2, 4 and  Yen-Chu Huang2, 3*
  • 1Department of Diagnostic Radiology, Chiayi Chang Gung Memorial Hospital, Taiwan
  • 2College of Medicine, Chang Gung University, Taiwan
  • 3Department of Neurology, Chiayi Chang Gung Memorial Hospital, Taiwan
  • 4Department of Neurosurgery, Chiayi Chang Gung Memorial Hospital, Taiwan
  • 5Department of Emergency Medicine, Chiayi Chang Gung Memorial Hospital, Taiwan

Background: Chronic kidney disease (CKD) has been closely associated with hypertension and stroke. Although studies have reported the relationship between CKD and cerebral small vessel disease (SVD), the link between CKD, hypertension, and SVD is uncertain. The aim of this study was to investigate the association between CKD and SVD in patients with strictly hypertensive intracerebral hemorrhage (ICH).
Methods: 142 patients with acute hypertensive ICH were enrolled in this study. Magnetic resonance imaging was performed to assess imaging markers for SVD. Patients were categorized into 3 CKD groups based on the degree of kidney dysfunction (GFR in mL/min per 1.73 m2): normal kidney function (GFR ≥ 90), mild kidney disease (60 ≤ GFR < 90), and moderate to severe kidney disease (GFR < 60).
Results: The prevalence rate of mild and moderate to severe CKD was 50% and 14.8%, respectively. The stage of CKD was associated with history of chronic hypertension (p = 0.046) as well as the prevalence rate of overall and deep cerebral microbleed (CMB) (p=0.001 and p=0.002, respectively). The stage of CKD was a significant risk factor for deep white matter hyperintensity (WMH) (OR 1.848; 95% CI 1.022-3.343, p = 0.042), overall CMB (OR 2.628; 95% CI 1.462-4.724, p = 0.001), lobar CMB (OR 2.106; 95% CI 1.119-3.963, p = 0.021), and deep CMB (OR 2.237; 95% CI 1.263-3.960, p= 0.006), even after adjustment for confounders.
Conclusions: In patients with hypertensive ICH, the prevalence of CKD is high even at the early stage of renal function impairment and is associated with the prevalence of CMB and deep WMH. These results reinforce the notion of a link between hypertensive vasculopathy, renal function impairment, and cerebral SVD.

Keywords: Chronic Kidney Disease, Hypertension, Brain hemorrhages, small vessel disease, Magnetic Resonance Imaging

Received: 16 Nov 2017; Accepted: 11 Apr 2018.

Edited by:

Andreas Charidimou, Harvard Medical School, United States

Reviewed by:

Gian Marco De Marchis, Universität Basel, Switzerland
Henry Ma, Monash University, Australia
Marco Pasi, Massachusetts General Hospital, Harvard Medical School, United States  

Copyright: © 2018 Tsai, Lee, Lee, Lin, Chang, Weng, Yang and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
MD, PhD. Yuan-Hsiung Tsai, Chiayi Chang Gung Memorial Hospital, Department of Diagnostic Radiology, Chiayi City, Taiwan, russell.tsai@gmail.com
MD. Yen-Chu Huang, Chang Gung University, College of Medicine, Guishan District, Taiwan, deepblue@adm.cgmh.org.tw