From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD.
Neurology. 2020 Jun 2;94(22):e2361-e2372. doi: 10.1212/WNL.0000000000009311. Epub 2020 Apr 17.
To test the association between reduced kidney function (assessed by estimated glomerular filtration rate [eGFR] and cystatin C [CysC]) and kidney damage (assessed by urinary albumin-to-creatinine ratio [ACR]) and intracranial atherosclerotic disease (ICAD) by high-resolution vessel wall MRI (VWMRI) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).
We conducted a cross-sectional analysis of ARIC participants with data on kidney measures and VWMRI in 2011 to 2013. The main outcomes were presence of intracranial plaques and luminal stenosis. Multivariable models were adjusted for demographics, cardiovascular risk factors, and use of antithrombotic medications.
A total of 1,762 participants (mean ± SD age, 76.3 ± 5.3) were included. eGFR based on CysC (eGFRcysc) <60 mL/min/1.73 m (vs ≥60 mL/min/1.73 m) was associated with plaque presence (adjusted odds ratio [OR] 1.29, 95% confidence interval [CI] 1.04-1.60), any detectable stenosis (adjusted OR 1.31, 95% CI 1.04-1.63), and >70% stenosis or occlusion (adjusted OR 2.15, 95% CI 1.32-3.50). Neither ACR nor CysC showed statistically significant associations with ICAD features in adjusted models. In adjusted multinomial models, participants with eGFRcysc <60 mL/min/1.73 m (vs ≥60 mL/min/1.73 m) had an increased OR of 1.41 (95% CI 1.06-1.87) for having 1 plaque (vs none) but no significant increase for multiple plaques; ACR ≥30 was associated with moderate (50%-70%) stenosis (OR 2.01, 95% CI 1.14-3.55) vs absent or less than 50% stenosis.
In community-dwelling older adults, reduced kidney function or elevated kidney damage was associated with ICAD measured by VWMRI. This finding may help to better identify a population at high risk for ICAD.
通过社区动脉粥样硬化风险研究（ARIC-NCS）中的高分辨率血管壁磁共振成像（VWMRI），检验肾小球滤过率（eGFR）和胱抑素 C（CysC）评估的肾功能降低与尿白蛋白与肌酐比值（ACR）评估的肾损伤与颅内动脉粥样硬化性疾病（ICAD）之间的相关性。
我们对 2011 年至 2013 年期间有肾脏指标和 VWMRI 数据的 ARIC 参与者进行了横断面分析。主要结局为颅内斑块和管腔狭窄的存在。多变量模型调整了人口统计学、心血管危险因素和抗血栓药物的使用。
共纳入 1762 名参与者（平均年龄±标准差为 76.3±5.3 岁）。CysC 估计肾小球滤过率（eGFRcysc）<60 mL/min/1.73 m（<60 mL/min/1.73 m）与斑块存在（校正比值比 [OR] 1.29，95%置信区间 [CI] 1.04-1.60）、任何可检测到的狭窄（校正 OR 1.31，95% CI 1.04-1.63）和>70%狭窄或闭塞（校正 OR 2.15，95% CI 1.32-3.50）相关。在调整后的模型中，ACR 和 CysC 与 ICAD 特征均无统计学显著相关性。在调整后的多项模型中，eGFRcysc<60 mL/min/1.73 m（<60 mL/min/1.73 m）的参与者斑块存在的 OR 为 1.41（95% CI 1.06-1.87），但不存在多个斑块的显著增加；ACR≥30 与中度（50%-70%）狭窄（OR 2.01，95% CI 1.14-3.55）相关，而与无狭窄或小于 50%狭窄无关。
在社区居住的老年人中，通过 VWMRI 测量的肾功能降低或肾损伤增加与 ICAD 相关。这一发现可能有助于更好地识别 ICAD 高危人群。
