Cerebral Small Vessel Disease and Renal Function: Systematic Review and Meta-Analysis

被引:81
作者
Makin, Stephen D. J. [1 ]
Cook, F. A. B. [2 ]
Dennis, Martin S. [2 ]
Wardlaw, Joanna M. [2 ]
机构
[1] Univ Edinburgh, Edinburgh EH4 2XU, Midlothian, Scotland
[2] Univ Edinburgh, Western Gen Hosp, Div Neuroimaging Sci, Edinburgh EH4 2XU, Midlothian, Scotland
基金
英国惠康基金;
关键词
Lacunar stroke; Renal function; Small vessel disease; Proteinuria; CHRONIC KIDNEY-DISEASE; WHITE-MATTER HYPERINTENSITY; GLOMERULAR-FILTRATION-RATE; ACUTE ISCHEMIC-STROKE; RISK-FACTOR; ENDOTHELIAL DYSFUNCTION; BRAIN INFARCTS; CYSTATIN-C; MICROALBUMINURIA; LESIONS;
D O I
10.1159/000369777
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: The small vessel disease (SVD) that appears in the brain may be part of a multisystem disorder affecting other vascular beds such as the kidney and retina. Because renal failure is associated with both stroke and white matter hyper-intensities we hypothesised that small vessel (lacunar) stroke would be more strongly associated with renal failure than cortical stroke. Therefore, we performed a systematic review and meta-analysis to establish first if lacunar stroke was associated with the renal function, and second, if cerebral small vessel disease seen on the MRI of patients without stroke was more common in patients with renal failure. Methods: We searched Medline and EMBASE for studies in adults with cerebral SVD (lacunar stroke or white matter hyper intensities (WMH) on Magnetic Resonance Imaging (MRI)), in which renal function was assessed (estimated glomerular filtration rate (eGFR) or proteinuria). We extracted data on SVD diagnosis, renal function, demographics and comorbidities. We performed two meta-analyses: first, we calculated the odds of renal impairment in lacunar (small vessel) ischaemic stroke compared to other ischaemic stroke subtypes (non-small vessel disease); and second, we calculated the odds of renal impairment in non-stroke individuals with WMH on MRI compared to individuals without WMH. We then performed a sensitivity analysis by excluding studies with certain characteristics and repeating the meta-analysis calculation. Results: After screening 11,001 potentially suitable titles, we included 37 papers reporting 32 studies of 20,379 subjects: 15 of stroke patients and 17 of SVD features in non-stroke patients. To diagnose lacunar stroke, 13/15 of the studies used risk factor-based classification (none used diffusion-weighted MRI). 394/1,119 (35%) of patients with lacunar stroke had renal impairment compared with 1,443/4,217 (34%) of patients with non-lacunar stroke, OR 0.88, (95% CI 0.6-1.30). In individuals without stroke the presence of SVD was associated with an increased risk of renal impairment (whether proteinuria or reduced eGFR) OR 2.33 (95% CI 1.80-3.01), when compared to those without SVD. After adjustment for age and hypertension, 15/21 studies still reported a significant association between renal impairment and SVD. Conclusion: We found no specific association between renal impairment and lacunar stroke, but we did find that in individuals who had not had a stroke, having more SVD features on imaging was associated with a worse renal function, which remained significant after controlling for hypertension. However, this finding does not exclude a powerful co-associate effect of age or vascular risk factor exposure. Future research should subtype lacunar stroke sensitively and control for major risk factors. (C) 2014 S. Karger AG, Basel
引用
收藏
页码:39 / 52
页数:14
相关论文
共 50 条
[1]   CLASSIFICATION OF SUBTYPE OF ACUTE ISCHEMIC STROKE - DEFINITIONS FOR USE IN A MULTICENTER CLINICAL-TRIAL [J].
ADAMS, HP ;
BENDIXEN, BH ;
KAPPELLE, LJ ;
BILLER, J ;
LOVE, BB ;
GORDON, DL ;
MARSH, EE ;
KASE, CS ;
WOLF, PA ;
BABIKIAN, VL ;
LICATAGEHR, EE ;
ALLEN, N ;
BRASS, LM ;
FAYAD, PB ;
PAVALKIS, FJ ;
WEINBERGER, JM ;
TUHRIM, S ;
RUDOLPH, SH ;
HOROWITZ, DR ;
BITTON, A ;
MOHR, JP ;
SACCO, RL ;
CLAVIJO, M ;
ROSENBAUM, DM ;
SPARR, SA ;
KATZ, P ;
KLONOWSKI, E ;
CULEBRAS, A ;
CAREY, G ;
MARTIR, NI ;
FICARRA, C ;
HOGAN, EL ;
CARTER, T ;
GURECKI, P ;
MUNTZ, BK ;
RAMIREZLASSEPAS, M ;
TULLOCH, JW ;
QUINONES, MR ;
MENDEZ, M ;
ZHANG, SM ;
ALA, T ;
JOHNSTON, KC ;
ANDERSON, DC ;
TARREL, RM ;
NANCE, MA ;
BUDLIE, SR ;
DIERICH, M ;
HELGASON, CM ;
HIER, DB ;
SHAPIRO, RA .
STROKE, 1993, 24 (01) :35-41
[2]   The role of microalbuminuria and insulin resistance as significant risk factors for white matter lesions in Japanese type 2 diabetic patients [J].
Anan, Futoshi ;
Masaki, Takayuki ;
Iwao, Tetsu ;
Eto, Takeshi ;
Shirnomura, Tsuyoshi ;
Umeno, Yoshikazu ;
Eshima, Nobuoki ;
Saikawa, Tetsunori ;
Yoshimatsu, Hironobu .
CURRENT MEDICAL RESEARCH AND OPINION, 2008, 24 (06) :1561-1567
[3]   CLASSIFICATION AND NATURAL-HISTORY OF CLINICALLY IDENTIFIABLE SUBTYPES OF CEREBRAL INFARCTION [J].
BAMFORD, J ;
SANDERCOCK, P ;
DENNIS, M ;
BURN, J ;
WARLOW, C .
LANCET, 1991, 337 (8756) :1521-1526
[4]   Microalbuminuria in ischemic stroke [J].
Beamer, NB ;
Coull, BM ;
Clark, WM ;
Wynn, M .
ARCHIVES OF NEUROLOGY, 1999, 56 (06) :699-702
[5]   Relationship between chronic kidney disease and silent cerebral infarction in patients with Type 2 diabetes [J].
Bouchi, R. ;
Babazono, T. ;
Yoshida, N. ;
Nyumura, I. ;
Toya, K. ;
Hayashi, T. ;
Hanai, K. ;
Tanaka, N. ;
Ishii, A. ;
Iwamoto, Y. .
DIABETIC MEDICINE, 2010, 27 (05) :538-543
[6]   Impact of Decreased Estimated Glomerular Filtration Rate on Japanese Acute Stroke and Its Subtype [J].
Chinda, Junko ;
Nakagawa, Naoki ;
Kabara, Maki ;
Matsuki, Motoki ;
Endo, Hisako ;
Saito, Tsukasa ;
Sawada, Jun ;
Katayama, Takayuki ;
Sato, Nobuyuki ;
Hasebe, Naoyuki .
INTERNAL MEDICINE, 2012, 51 (13) :1661-1666
[7]   Adults With Late Stage 3 Chronic Kidney Disease Are at High Risk for Prevalent Silent Brain Infarction A Population-Based Study [J].
Chou, Chia-Chi ;
Lien, Li-Ming ;
Chen, Wei-Hung ;
Wu, Mai-Szu ;
Lin, Shiue-Ming ;
Chiu, Hou-Chang ;
Chiou, Hung-Yi ;
Bai, Chyi-Huey .
STROKE, 2011, 42 (08) :2120-2125
[8]  
Das P, 2012, Mymensingh Med J, V21, P709
[9]   Microvascular Determinants of Cognitive Decline and Brain Volume Change in Elderly Patients with Type 2 Diabetes [J].
de Bresser, Jeroen ;
Reijmer, Yael D. ;
van den Berg, Esther ;
Breedijk, Marja A. ;
Kappelle, L. Jaap ;
Viergever, Max A. ;
Biessels, Geert Jan .
DEMENTIA AND GERIATRIC COGNITIVE DISORDERS, 2010, 30 (05) :381-386
[10]   Smoking is associated with silent cerebrovascular disease in a high-risk Japanese community-dwelling population [J].
Eguchi, K ;
Kario, K ;
Hoshide, S ;
Hoshide, Y ;
Ishikawa, J ;
Morinari, M ;
Hashimoto, T ;
Shimada, K .
HYPERTENSION RESEARCH, 2004, 27 (10) :747-754