Bi Rentang, Wei Yanhao, Li Pengcheng, Peng Haokun, Alizadeh Mohammad, Hu Bo, Li Yanan
Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China.
Department of Ophthalmology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China.
J Am Heart Assoc. 2025 May 6;14(9):e038711. doi: 10.1161/JAHA.124.038711. Epub 2025 Apr 23.
The relationship between chronic kidney disease (CKD) and cerebral small vessel disease has been inconsistently reported. In particular, there is a lack of research focusing on patients with acute ischemic stroke, a key area that could provide important insights into the brain-kidney connection.
We established a large-sample size, multicenter prospective cohort study (SMART [Cerebral Small Vascular Disease Registry Multicenter Clinical Trial]) across 13 subcenters in central China. All participants underwent long-term, continuous renal function monitoring. CKD was assessed using the Kidney Disease Improving Global Outcomes criteria, defined as abnormal kidney function lasting for at least 3 consecutive months. Magnetic resonance imaging, including T2-weighted and susceptibility-weighted imaging, was used to detect markers of cerebral small vessel disease such as white matter hyperintensities, cerebral microbleeds, lacunar infarctions, and enlarged perivascular spaces. Multinomial, binomial, and ordinal logistic regression models were employed, adjusting for demographic, vascular, and stroke-related factors. Among the 3909 patients with acute ischemic stroke (mean age 62 years, 35.3% female), 307 (7.9%) were diagnosed with CKD. Higher CKD risk grades were correlated with an increased burden of cerebral small vessel disease. After adjusting confounding factors, white matter hyperintensities (odds ratio [OR], 1.841 [95% CI, 1.413-2.400], <0.001), lacunar infarctions (OR, 3.455 [95% CI, 2.314-5.158], <0.001), and cerebral microbleeds (OR, 2.514 [95% CI, 1.976-3.199], =0.005) were significantly more frequent in patients with CKD. Additionally, patients with CKD exhibited higher rates of cardiac embolism (OR, 1.405 [95% CI, 1.067-1.851], =0.016) compared with other stroke causes.
Stroke clinicians should recognize CKD as a potentially independent and modifiable risk factor for cerebral small vessel disease.
慢性肾脏病（CKD）与脑小血管病之间的关系报道不一。特别是，缺乏针对急性缺血性脑卒中患者的研究，而这一关键领域可能为脑-肾关联提供重要见解。
我们在中国中部的13个分中心开展了一项大样本、多中心前瞻性队列研究（SMART[脑小血管病登记多中心临床试验]）。所有参与者均接受长期、连续的肾功能监测。采用改善全球肾脏病预后组织（KDIGO）标准评估CKD，定义为肾功能异常持续至少3个月。利用磁共振成像，包括T2加权成像和磁敏感加权成像，检测脑小血管病标志物，如白质高信号、脑微出血、腔隙性脑梗死和血管周围间隙增宽。采用多项、二项和有序逻辑回归模型，并对人口统计学、血管和卒中相关因素进行校正。在3909例急性缺血性脑卒中患者（平均年龄62岁，女性占35.3%）中，307例（7.9%）被诊断为CKD。CKD风险等级越高，与脑小血管病负担增加相关。校正混杂因素后，CKD患者白质高信号（比值比[OR]，1.841[95%可信区间，1.413 - 2.400]，P<0.001）、腔隙性脑梗死（OR，3.455[95%可信区间，2.314 - 5.158]，P<0.001）和脑微出血（OR，2.514[95%可信区间，1.976 - 3.199]，P = 0.005）的发生率显著更高。此外，与其他卒中病因相比，CKD患者的心源性栓塞发生率更高（OR，1.405[95%可信区间，1.067 - 1.851]，P = 0.016）。
卒中临床医生应认识到CKD是脑小血管病潜在的独立且可改变的危险因素。
