NDT Advance Access published online on August 12, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn419
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Relationship between silent brain infarction and chronic kidney disease
1 Division of Nephrology and Hypertension, Yokohama City University Medical Center 2 Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine and School of Medicine, Yokohama, Japan
Correspondence and offprint requests to: Nobuhito Hirawa, Division of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. Tel: +81-45-261-5656; Fax: +81-45-253-5713; E-mail: hirawa{at}med.yokohama-cu.ac.jp
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Abstract |
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Background. The presence of silent brain infarction (SBI) increases the risk of symptomatic stroke and dementia. The association between SBI and chronic kidney disease (CKD) has not been clarified. Moreover, little is known about what factors are related to SBI in CKD patients and whether the prevalence of SBI differs in CKD stage or cause of CKD.
Methods. This is a cross-sectional study. A total of 375 subjects—335 with CKD and 40 with essential hypertension—were included. All subjects underwent magnetic resonance imaging (MRI) of the brain to detect SBI. Glomerular filtration rate (GFR) was estimated using Modification of Diet in Renal Disease equation, and cardiovascular risk factors were examined.
Results. The prevalence of SBI was 56.5% in all subjects. Among causes of CKD, hypertensive nephrosclerosis had a strong association with SBI. According to the estimated GFR (eGFR) stage, the more severe the stage of eGFR, the higher the prevalence of SBI (age-adjusted odds ratio [95% confidence interval] for eGFR 30–59, 15–29 and <15 versus 
60 mL/min/1.73 m2: 1.34 [0.68–1.99], 1.94 [1.30–2.57] and 2.51 [1.91–3.10]). In multivariate logistic analysis, eGFR was related to SBI independently, in addition to age and blood pressure (P = 0.025). However, other traditional and non-traditional risk factors were not.
Conclusion. There was an independent association between eGFR and SBI. CKD patients should receive active detection of SBI and more intensive preventive management, especially for hypertension, should be needed in CKD patients to prevent SBI.
Keywords: chronic kidney disease; glomerular filtration rate; hypertension; magnetic resonance imaging; silent brain infarction
Received for publication: 18. 3.08
Accepted in revised form: 2. 7.08
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