Tamura Manjula Kurella, Pajewski Nicholas M, Bryan R Nick, Weiner Daniel E, Diamond Matthew, Van Buren Peter, Taylor Addison, Beddhu Srinivasan, Rosendorff Clive, Jahanian Hesamoddin, Zaharchuk Greg
From the Geriatric Research and Education Clinical Center (M.K.T.), Palo Alto VA Health Care System; Division of Nephrology (M.K.T.) and Department of Radiology (H.J., G.Z.), Stanford University School of Medicine, Palo Alto, CA; Department of Biostatistical Sciences (N.M.P.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia; Division of Nephrology (D.E.W.), Tufts Medical Center, Boston, MA; Division of Nephrology (M.D.), Georgia Regents University, Augusta; Department of Medicine (P.V.B.), University of Texas Southwestern Medical Center, Dallas; Department of Medicine (A.T.), Baylor College of Medicine, Houston, TX; Division of Nephrology (S.B.), University of Utah, Salt Lake City; and Division of Cardiology (C.R.), Icahn School of Medicine and James J. Peters VA, New York, NY.
Neurology. 2016 Mar 29;86(13):1208-16. doi: 10.1212/WNL.0000000000002527. Epub 2016 Feb 26.
To determine the relation between markers of kidney disease-estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR)-with cerebral blood flow (CBF) and white matter volume (WMV) in hypertensive adults.
We used baseline data collected from 665 nondiabetic hypertensive adults aged ≥50 years participating in the Systolic Blood Pressure Intervention Trial (SPRINT). We used arterial spin labeling to measure CBF and structural 3T images to segment tissue into normal and abnormal WMV. We used quantile regression to estimate the association between eGFR and UACR with CBF and abnormal WMV, adjusting for sociodemographic and clinical characteristics.
There were 218 participants (33%) with eGFR <60 mL/min/1.73 m(2) and 146 participants (22%) with UACR ≥30 mg/g. Reduced eGFR was independently associated with higher adjusted median CBF, but not with abnormal WMV. Conversely, in adjusted analyses, there was a linear independent association between UACR and larger abnormal WMV, but not with CBF. Compared to participants with neither marker of CKD (eGFR ≥60 mL/min/1.73 m(2) and UACR <30 mg/g), median CBF was 5.03 mL/100 g/min higher (95% confidence interval [CI] 0.78, 9.29) and abnormal WMV was 0.63 cm(3) larger (95% CI 0.08, 1.17) among participants with both markers of CKD (eGFR <60 mL/min/1.73 m(2) and UACR ≥30 mg/g).
Among nondiabetic hypertensive adults, reduced eGFR was associated with higher CBF and higher UACR was associated with larger abnormal WMV.
确定高血压成年患者中肾病标志物——估计肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（UACR）——与脑血流量（CBF）和白质体积（WMV）之间的关系。
我们使用了从665名年龄≥50岁的非糖尿病高血压成年患者收集的基线数据，这些患者参与了收缩压干预试验（SPRINT）。我们使用动脉自旋标记来测量CBF，并使用3T结构图像将组织分割为正常和异常WMV。我们使用分位数回归来估计eGFR和UACR与CBF和异常WMV之间的关联，并对社会人口统计学和临床特征进行了调整。
有218名参与者（33%）的eGFR<60 mL/min/1.73 m²，146名参与者（22%）的UACR≥30 mg/g。eGFR降低与调整后的中位CBF升高独立相关，但与异常WMV无关。相反，在调整分析中，UACR与较大的异常WMV之间存在线性独立关联，但与CBF无关。与既没有慢性肾脏病标志物（eGFR≥60 mL/min/1.73 m²且UACR<30 mg/g）的参与者相比，同时具有两种慢性肾脏病标志物（eGFR<60 mL/min/1.73 m²且UACR≥30 mg/g）的参与者的中位CBF高5.03 mL/100 g/min（95%置信区间[CI] 0.78，9.29），异常WMV大0.63 cm³（95%CI 0.08，1.17）。
在非糖尿病高血压成年患者中，eGFR降低与较高的CBF相关，UACR升高与较大的异常WMV相关。
