一般老年高血压人群中的慢性肾脏病及其与脑小血管病的关系。
Chronic kidney disease and its association with cerebral small vessel disease in the general older hypertensive population.
机构信息
Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Lund University and Skåne University Hospital, Jan Waldenströms gata 35, pl 13, 205 02, Malmö, Sweden.
Department of Clinical Sciences in Lund, Division of Diagnostic Radiology, Lund University, 221 85, Lund, Sweden.
出版信息
BMC Nephrol. 2024 Mar 13;25(1):93. doi: 10.1186/s12882-024-03528-8.
BACKGROUND
Cerebral small vessel disease can be identified using magnetic resonance imaging, and includes white matter hyperintensities, lacunar infarcts, cerebral microbleeds, and brain atrophy. Cerebral small vessel disease and chronic kidney disease share many risk factors, including hypertension. This study aims to explore an association between chronic kidney disease and cerebral small vessel disease, and also to explore the role of hypertension in this relationship.
METHODS
With a cross sectional study design, data from 390 older adults was retrieved from the general population study Good Aging in Skåne. Chronic kidney disease was defined as glomerular filtration rate < 60 ml/min/1,73m. Associations between chronic kidney disease and magnetic resonance imaging markers of cerebral small vessel disease were explored using logistic regression models adjusted for age and sex. In a secondary analysis, the same calculations were performed with the study sample stratified based on hypertension status.
RESULTS
In the whole group, adjusted for age and sex, chronic kidney disease was not associated with any markers of cerebral small vessel disease. After stratification by hypertension status and adjusted for age and sex, we observed that chronic kidney disease was associated with cerebral microbleeds (OR 1.93, CI 1.04-3.59, p-value 0.037), as well as with cortical atrophy (OR 2.45, CI 1.34-4.48, p-value 0.004) only in the hypertensive group. In the non-hypertensive group, no associations were observed.
CONCLUSIONS
In this exploratory cross-sectional study, we observed that chronic kidney disease was associated with markers of cerebral small vessel disease only in the hypertensive subgroup of a general population of older adults. This might indicate that hypertension is an important link between chronic kidney disease and cerebral small vessel disease. Further studies investigating the relationship between CKD, CSVD, and hypertension are warranted.
背景
脑小血管病可通过磁共振成像识别，包括脑白质高信号、腔隙性梗死、脑微出血和脑萎缩。脑小血管病和慢性肾脏病有许多共同的危险因素，包括高血压。本研究旨在探讨慢性肾脏病与脑小血管病之间的关联，以及高血压在这种关系中的作用。
方法
采用横断面研究设计，从斯科讷省老年人一般人群研究中检索了 390 名老年人的数据。慢性肾脏病定义为肾小球滤过率<60ml/min/1.73m。使用逻辑回归模型，根据年龄和性别调整，探讨了慢性肾脏病与脑小血管病磁共振成像标志物之间的关联。在二次分析中，根据高血压状况对研究样本进行分层，并对相同的计算进行了分析。
结果
在整个组中，根据年龄和性别调整后，慢性肾脏病与任何脑小血管病标志物均无关联。根据高血压状况分层并根据年龄和性别调整后，我们观察到慢性肾脏病与脑微出血（OR 1.93，CI 1.04-3.59，p 值 0.037）以及皮质萎缩（OR 2.45，CI 1.34-4.48，p 值 0.004）相关，仅在高血压组中。在非高血压组中，未观察到相关性。
结论
在这项探索性横断面研究中，我们观察到慢性肾脏病与脑小血管病标志物的相关性仅在一般老年人群的高血压亚组中存在。这可能表明高血压是慢性肾脏病与脑小血管病之间的重要联系。需要进一步研究来探讨 CKD、CSVD 和高血压之间的关系。
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