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NDT Advance Access published online on September 23, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn535
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Chronic kidney disease, hypertension and silent brain infarction

Correspondence and offprint requests to: E-mail: nephro{at}dir.bg

Sir,

We read with great interest the recent article by Kobayashi et al. [1] in the August Advance Access of Nephrology Dialysis Transplantation. In this cross-sectional study in 335 with chronic kidney disease (CKD) and 40 with essential hypertension patients, the authors found an independent association between glomerular filtration rate (GFR) and silent brain infarction (SBI).

We agree with them that CKD patients because of greater prevalence of SBI should receive active detection of SBI and more intensive treatment for hypertension. But considering the design of the study, the association between GFR and SBI is not proved to be independent. Blood pressure levels are good but not sufficient adjustment for hypertension. Patients with identical hypertensive current measurements may be at different risk of stroke, depending on how long they have been hypertensive [2]. The duration and severity of hypertension increase progressively with the stage of renal disease even when hypertension is not a primary cause for renal damage [3]. This necessitates additional adjustment for hypertension duration and its control status.

The estimation of hypertension duration is relatively easy, even if not always precise, being based mainly on information from self-reports and medical records. We suppose that CKD patients with an estimated longer duration of elevated high blood pressure will to the same extent be more likely to have SBI. Opthalmoscopy, although there may be some controversies, can be used in the detection of severity of hypertension [4]. This is also appropriate because of the close correlation between retinal and cerebral arteriolar findings shown in Goto and colleagues’ autopsy study of patients with stroke [5].

Conflict of interest statement. None declared.

Editorial Note: Dr Kobayashi et al. had no further comments on this letter.

Plamen Yovchevski1, Evgeniy Goshev2 and Kosta Kostov3

1 Nephrological Department 2 Cardiological Department 3 Neurological Department, Medical Institute of Ministry of Interior Sofia, Bulgaria

References

  1. Kobayashi M, Hirawa N, Yatsu K, et al. Relationship between silent brain infarction and chronic kidney disease. Nephrol Dial Transplant. doi 10.1093/ndt/gfn419 [epub ahead of print].
  2. Awad IA, Johnson PC, Spetzler RF, et al. Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. Stroke (1986) 17:1084–1089.[Abstract/Free Full Text]
  3. Perneger TV, Whelton PK, Klag MJ. History of hypertension in patients treated for end-stage renal disease. J Hypertens (1997) 15:451–456.[CrossRef][Web of Science][Medline]
  4. Schubert HD. Ocular manifestations of systemic hypertension. Curr Opin Ophthalmol (1998) 9:69–72.[Medline]
  5. Goto I, Katsuki S, Ikui H, et al. Pathological studies on the intracerebral and retinal arteries in cerebrovascular and noncerebrovascular diseases. Stroke (1975) 6:263–269.[Abstract/Free Full Text]

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This Article
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