Ikram M Arfan, Vernooij Meike W, Hofman Albert, Niessen Wiro J, van der Lugt Aad, Breteler Monique M B
Department of Epidemiology & Biostatistics, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Stroke. 2008 Jan;39(1):55-61. doi: 10.1161/STROKEAHA.107.493494. Epub 2007 Nov 29.
Poor kidney function, as measured by glomerular filtration rate (GFR), is closely associated with presence of glomerular small vessel disease. Given the hemodynamic similarities between the vascular beds of the kidney and the brain, we hypothesized an association between kidney function and markers of cerebral small vessel disease on MRI. We investigated this association in a population-based study of elderly persons.
We measured GFR using the Cockcroft-Gault equation in 484 participants (60 to 90 years of age) from the Rotterdam Scan Study. Using automated MRI-analysis we measured global as well as lobar and deep volumes of gray matter and white matter, and volume of WML. Lacunar infarcts were rated visually. Volumes of deep white matter and WML and presence of lacunar infarcts reflected cerebral small vessel disease. We used linear and logistic regression models to investigate the association between GFR and brain imaging parameters. Analyses were adjusted for age, sex, and additionally for cardiovascular risk factors.
Persons with lower GFR had less deep white matter volume (difference in standardized volume per SD decrease in GFR: -0.15 [95% CI -0.26 to -0.04]), more WML (difference per SD decrease in GFR: 0.14 [95% CI 0.03 to 0.25]), and more often lacunar infarcts, although the latter was not significant. GFR was not associated with gray matter volume or lobar white matter volume. Additional adjustment for cardiovascular risk factors yielded similar results.
Impaired kidney function is associated with markers of cerebral small vessel disease as assessed on MRI.
通过肾小球滤过率（GFR）衡量的肾功能不佳与肾小球小血管疾病的存在密切相关。鉴于肾脏和大脑血管床之间的血流动力学相似性，我们推测肾功能与MRI上脑小血管疾病标志物之间存在关联。我们在一项基于人群的老年人研究中调查了这种关联。
我们使用Cockcroft - Gault方程在鹿特丹扫描研究的484名参与者（60至90岁）中测量GFR。使用自动MRI分析，我们测量了灰质和白质的总体积以及叶和深部体积，以及白质高信号（WML）的体积。腔隙性梗死通过视觉评分。深部白质和WML的体积以及腔隙性梗死的存在反映了脑小血管疾病。我们使用线性和逻辑回归模型来研究GFR与脑成像参数之间的关联。分析针对年龄、性别进行了调整，并额外针对心血管危险因素进行了调整。
GFR较低的人深部白质体积较小（GFR每降低1个标准差，标准化体积差异：-0.15 [95%可信区间 -0.26至-0.04]），WML较多（GFR每降低1个标准差，差异：0.14 [95%可信区间0.03至0.25]），并且腔隙性梗死更常见，尽管后者不显著。GFR与灰质体积或叶白质体积无关。对心血管危险因素进行额外调整产生了类似的结果。
肾功能受损与MRI评估的脑小血管疾病标志物相关。
