Department of Neurology, Kyoto Second Red Cross Hospital, Haruobicho Kamigyoku, Kyoto, Japan.
Hypertens Res. 2011 Dec;34(12):1276-82. doi: 10.1038/hr.2011.118. Epub 2011 Aug 11.
Although the relationships between chronic kidney disease (CKD) and cognitive impairment (CI) have been highlighted, the etiology of CI in CKD remains uncertain. Subjects comprised 224 consecutive patients with symptomatic lacunar infarction who underwent magnetic resonance imaging and ambulatory blood pressure monitoring (ABPM). Diurnal blood pressure (BP) patterns were categorized into three groups: dippers, non-dippers and risers. Lacunar infarcts (LIs), including both symptomatic and silent and diffuse white matter lesions (WMLs), were graded into three grades according to their degree. The results of kidney function were evaluated using estimated glomerular filtration rate (eGFR), categorized into three groups: stage 1, >60; stage 2, 30-60; and stage 3, <30 ml min(-1) per 1.73 m(2). There were 44 patients with CI. Confluent WMLs, including WML 2 and WML 3, were found in 36 patients (81.8%), and multiple lacunae including LI 2 and LI 3 were found in 30 patients (68.1%) with CI. Age >75 years (odds ratio (OR), 5.5; P<0.05), male sex (OR, 2.8; P<0.05), non-dippers (OR, 6.3; P<0.05) and risers (OR, 5.6; P<0.05), eGFR 30-60 ml min(-1) per 1.73 m(2) (OR, 2.9; P<0.05) and eGFR <30 ml min(-1) per 1.73 m(2) (OR, 23.8; P<0.01), WML grade 2 (OR, 5.1; P<0.01) and WML grade 3 (OR, 45.2; P<0.001) and LI grade 2 (OR, 3.2; P<0.05) and LI grade 3 (OR, 6.4; P<0.05) were independently associated with CI. Age >75 years (OR, 4.1; P<0.05), eGFR 30-60 ml min(-1) per 1.73 m(2) (OR, 3.7; P<0.05) and eGFR <30 ml min(-1) per 1.73 m(2) (OR, 8.7; P<0.05) were independently associated with WML grade 3. Extensive small vessel diseases, CKD and non-dipping status were independently associated with CI. CKD appears to mainly contribute to vascular CI, whereas possibilities of overlapping with other mechanisms such as degenerative CI cannot be excluded. Strict night time BP control and renoprotective treatment may be warranted to prevent CI.
尽管慢性肾脏病 (CKD) 和认知障碍 (CI) 之间的关系已经得到强调，但 CKD 患者 CI 的病因仍不确定。研究对象包括 224 例有症状腔隙性梗死患者，这些患者均接受了磁共振成像和动态血压监测 (ABPM)。根据昼夜血压 (BP) 模式，将患者分为三组：杓型、非杓型和超杓型。根据病变程度，将腔隙性梗死 (LI) 分为三级，包括有症状和无症状的腔隙性梗死及弥漫性脑白质病变 (WML)。根据肾小球滤过率估计值 (eGFR) 将肾功能结果分为三组：eGFR>60 为第 1 期；eGFR 为 30-60 为第 2 期；eGFR<30 ml/min·1.73m(2)为第 3 期。有 44 例患者存在 CI。36 例患者（81.8%）存在弥漫性 WML2 和 WML3，30 例患者（68.1%）存在多个腔隙性梗死灶，包括 LI2 和 LI3。年龄>75 岁（比值比 (OR)，5.5；P<0.05）、男性（OR，2.8；P<0.05）、非杓型（OR，6.3；P<0.05）和超杓型（OR，5.6；P<0.05）、eGFR 为 30-60 ml/min·1.73m(2)（OR，2.9；P<0.05）和 eGFR<30 ml/min·1.73m(2)（OR，23.8；P<0.01）、WML 分级 2（OR，5.1；P<0.01）和 WML 分级 3（OR，45.2；P<0.001）、LI 分级 2（OR，3.2；P<0.05）和 LI 分级 3（OR，6.4；P<0.05）与 CI 独立相关。年龄>75 岁（OR，4.1；P<0.05）、eGFR 为 30-60 ml/min·1.73m(2)（OR，3.7；P<0.05）和 eGFR<30 ml/min·1.73m(2)（OR，8.7；P<0.05）与 WML 分级 3 独立相关。广泛的小血管疾病、CKD 和非杓型血压与 CI 独立相关。CKD 似乎主要导致血管性 CI，但不能排除与其他机制（如退行性 CI）重叠的可能性。为了预防 CI，可能需要严格控制夜间血压和肾脏保护治疗。
