Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Nephron. 2021;145(4):330-341. doi: 10.1159/000513121. Epub 2021 Apr 29.
Growing data indicate a higher prevalence of cerebrovascular diseases in patients with ESRD. Cerebral small-vessel disease (CSVD) is an important risk factor of stroke and dementia. A comprehensive assessment of CSVD in a dialysis population is needed.
In this retrospective cross-sectional study, we enrolled 179 dialysis patients and 351 controls matched by sex and age with normal serum creatinine. The presence and locations of 3 main features of CSVD in dialysis patients, including lacunes, cerebral microbleeds (CMBs), and white matter hyperintensities (WMHs), were evaluated with brain magnetic resonance imaging and compared with controls. Univariate and multivariate analyses were performed to identify risk factors.
Compared with controls, the prevalence of CSVD was significantly increased in dialysis patients (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.26-5.62). Among them, risks of CMBs and WMHs were increased in dialysis (OR 4.01, 95% CI 1.78-9.42; 3.91, 95% CI 1.67-9.15), except for lacunes. The age of subjects with CSVD detected was significantly younger in the dialysis group (p = 0.002). Unlike controls, basal ganglia were most affected by lacunes and CMBs in dialysis patients. In dialysis patients, multivariate analysis further revealed that aging, smoking, and hyperlipidemia were significantly associated with CSVD, while dialysis modality was not significant.
We demonstrated a higher prevalence and early-onset tendency of CSVD in dialysis patients, especially for CMBs and WMHs. Dialysis patients showed different patterns and associated factors for CSVD.
越来越多的数据表明，终末期肾病（ESRD）患者的脑血管疾病患病率更高。脑小血管病（CSVD）是中风和痴呆的重要危险因素。需要对透析人群的 CSVD 进行全面评估。
在这项回顾性横断面研究中，我们纳入了 179 名透析患者和 351 名按性别和年龄匹配的血清肌酐正常的对照组。使用脑部磁共振成像评估透析患者 CSVD 的 3 种主要特征（腔隙、脑微出血 [CMB] 和脑白质高信号 [WMH]）的存在和位置，并与对照组进行比较。进行单因素和多因素分析以确定危险因素。
与对照组相比，透析患者 CSVD 的患病率显著增加（比值比 [OR] 2.66，95%置信区间 [CI] 1.26-5.62）。其中，CMB 和 WMH 的风险在透析中增加（OR 4.01，95%CI 1.78-9.42；3.91，95%CI 1.67-9.15），但腔隙除外。在透析组中，检测到 CSVD 的患者的年龄明显较年轻（p=0.002）。与对照组不同，基底节在透析患者中最易受到腔隙和 CMB 的影响。在透析患者中，多因素分析进一步表明，年龄、吸烟和高脂血症与 CSVD 显著相关，而透析方式则不显著。
我们证明了透析患者 CSVD 的患病率更高且发病年龄更早，尤其是 CMB 和 WMH。透析患者的 CSVD 表现出不同的模式和相关因素。
