A cross-sectional study of presence of cerebral deep subcortical white matter hyperintensities and back ground in chronic kidney disease

Abstract

Patients with chronic kidney disease (CKD) have a higher risk for cerebrovascular disease than the general population. Magnetic resonance imaging (MRI) of the brain can detect cerebral small vessel disease, including deep and subcortical white matter hyperintensity (DSWMH). DSWMH reportedly confers a risk for stroke, and it is associated with dementia. We investigated DSWMH in predialysis CKD patients without neurological abnormalities. This cross-sectional study used plain 1.5T-MRI to assess DSWMH in 505 predialysis patients with CKD and 100 individuals without CKD between January 2008 and December 2011. The frequency of DSWMH was higher in patients with CKD (58%) than in patients without CKD (27%) and was more prevalent among patients without CKD who were older and had higher blood pressure, diabetes, anemia, and a smoking habit. The prevalence of DSWMH was similar (26%) between patients without CKD and patients with early CKD (stages 1–2). However, the prevalence of DSWMH increased with worsening CKD (stages G3, G4, and G5; 59%, 74%, and 78%, respectively). Patients with advanced CKD (stages G3, G4, and G5) had significantly increased severe Fazekas-DSWMH. Multivariate logistic regression analysis adjusted for age, sex, diabetes, and blood pressure revealed that eGFR was a significant factor associated with DSWMH independent of age, sex, diabetes, and blood pressure (eGFR: p<0.01, OR 1.01, 95%CI 1.00–1.03). We found that there is a high prevalence of DSWMH in patients with advanced CKD but no apparent neurological abnormalities, and that eGFR is an independent predictor of DSWMH.