Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA.
Kidney Int. 2018 Sep;94(3):608-615. doi: 10.1016/j.kint.2018.04.022. Epub 2018 Jun 28.
Decreased glomerular filtration rate (GFR) and albuminuria may be accompanied by brain pathology. Here we investigated whether changes in these kidney measures are linked to development of new MRI-detected infarcts and microbleeds, and progression of white matter hyperintensity volume. The study included 2671 participants from the population-based AGES-Reykjavik Study (mean age 75, 58.7% women). GFR was estimated from serum creatinine, and albuminuria was assessed by urinary albumin-to-creatinine ratio. Brain MRI was acquired at baseline (2002-2006) and 5 years later (2007-2011). New MRI-detected infarcts and microbleeds were counted on the follow-up scans. White matter hyperintensity progression was estimated as percent change in white matter hyperintensity volumes between the two exams. Participants with a large eGFR decline (over 3 ml/min/1.73m per year) had more incident subcortical infarcts (odds ratio 1.53; 95% confidence interval 1.05, 2.22), and more marked progression of white matter hyperintensity volume (difference: 8%; 95% confidence interval: 4%, 12%), compared to participants without a large decline. Participants with incident albuminuria (over 30 mg/g) had 21% more white matter hyperintensity volume progression (95% confidence interval: 14%, 29%) and 1.86 higher odds of developing new deep microbleeds (95% confidence interval 1.16, 2.98), compared to participants without incident albuminuria. The findings were independent of cardiovascular risk factors. Changes in kidney measures were not associated with occurrence of cortical infarcts. Thus, larger changes in eGFR and albuminuria are associated with increased risk for developing manifestations of cerebral small vessel disease. Individuals with larger changes in these kidney measures should be considered as a high risk population for accelerated brain pathology.
肾小球滤过率（GFR）和白蛋白尿的降低可能伴有脑部病变。在这里，我们研究了这些肾脏指标的变化是否与新的 MRI 检测到的梗死和微出血的发展以及白质高信号体积的进展有关。该研究包括来自基于人群的AGES-Reykjavik 研究的 2671 名参与者（平均年龄 75 岁，58.7%为女性）。GFR 由血清肌酐估计，白蛋白尿通过尿白蛋白与肌酐比值评估。脑部 MRI 在基线（2002-2006 年）和 5 年后（2007-2011 年）进行采集。在随访扫描中计算新的 MRI 检测到的梗死和微出血。白质高信号进展被估计为两次检查之间白质高信号体积的百分比变化。与没有大的 eGFR 下降的参与者相比，eGFR 大幅下降（每年超过 3ml/min/1.73m）的参与者发生皮质下梗死的几率更高（比值比 1.53；95%置信区间 1.05，2.22），白质高信号体积的进展更明显（差异：8%；95%置信区间：4%，12%）。与没有新发生白蛋白尿的参与者相比，有新发生白蛋白尿（超过 30mg/g）的参与者白质高信号体积的进展增加了 21%（95%置信区间：14%，29%），发生新深部微出血的几率增加了 1.86 倍（95%置信区间 1.16，2.98）。这些发现与心血管危险因素无关。肾脏指标的变化与皮质梗死的发生无关。因此，eGFR 和白蛋白尿的较大变化与发生脑小血管病表现的风险增加相关。这些肾脏指标变化较大的个体应被视为脑病理学加速的高危人群。
