Molad Jeremy, Miwa Kaori, Nash Philip S, Ambler Gareth, Best Jonathan, Wilson Duncan, Hallevi Hen, Fandler-Höfler Simon, Eppinger Sebastian, Du Houwei, Al-Shahi Salman Rustam, Jäger Hans R, Lip Gregory Y H, Goeldlin Martina B, Beyeler Morin, Bücke Philipp, El-Koussy Marwan, Mattle Heinrich Paul, Panos Leonidas D, van Dam-Nolen Dianne H K, Dubost Florian, Hendrikse Jeroen, Kooi M Eline, Mess Werner, Nederkoorn Paul J, Shiozawa Masayuki, Christ Nicolas, Bellut Maximilian, Gunkel Sarah, Karayiannis Christopher, Van Ly John, Singhal Shaloo, Slater Lee-Anne, Kim Young Dae, Song Tae-Jin, Lee Keon-Joo, Lim Jae-Sung, Hara Hideo, Nishihara Masashi, Tanaka Jun, Yoshikawa Masaaki, Demirelli Derya Selcuk, Tanriverdi Zeynep, Uysal Ender, Coutts Shelagh B, Chappell Francesca M, Makin Stephen, Mak Henry Ka-Fung, Teo Kay Cheong, Wong Debbie Y K, Hert Lisa, Kubacka Marta, Lyrer Philippe, Polymeris Alexandros A, Wagner Benjamin, Zietz Annaelle, Abrigo Jill M, Cheng Cyrus, Chu Winnie C W, Leung Thomas W H, Tsang Suk Fung, Yiu Brian, Seiffge David J, Fischer Urs, Jung Simon, Enzinger Christian, Gattringer Thomas, Bos Daniel, Toyoda Kazunori, Fluri Felix, Phan Thanh G, Srikanth Velandai, Heo Ji Hoe, Bae Hee-Joon, Yakushiji Yusuke, Orken Dilek Necioglu, Smith Eric E, Wardlaw Joanna M, Lau Kui Kai, Engelter Stefan T, Peters Nils, Soo Yannie, Wheeler David C, Simister Robert J, Bornstein Natan M, Werring David J, Ben Assayag Einor, Koga Masatoshi
Department of Stroke & Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
J Neurol Neurosurg Psychiatry. 2025 Apr 24. doi: 10.1136/jnnp-2024-335110.
Patients with chronic kidney disease are at increased risk of stroke and frequently have cerebral microbleeds. Whether such patients also encounter an increased risk of recurrent stroke has not been firmly established. We aimed to determine whether impaired kidney function is associated with the risk of recurrent stroke, and microbleed presence, distribution and severity.
We used pooled data from the Microbleeds International Collaborate Network to investigate associations of impaired kidney function, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m. Our primary outcome was a composite of recurrent ischaemic stroke (IS) and intracranial haemorrhage (ICrH). Secondary outcomes included: (1) individual components of the primary outcome; (2) modification of the primary outcome by microbleed presence or anticoagulant use and (3) microbleed presence, distribution and severity.
11 175 patients (mean age 70.7±12.6, 42% female) were included, of which 2815 (25.2%) had impaired kidney function. Compared with eGFR ≥60, eGFR <60 was associated with a higher risk of the primary outcome (adjusted HR, aHR 1.33 (95% CI 1.14 to 1.56), p<0.001) and higher rates of the recurrent IS (aHR 1.33 (95% CI 1.12 to 1.58)). Reduced eGFR was not associated with ICrH risk (aHR 1.07 (95% CI 0.70 to 1.60)). eGFR was also associated with microbleed presence (adjusted OR, aOR 1.14 (95% CI 1.03 to 1.26)) and severity (aOR 1.17 (95% CI 1.06 to 1.29)). Compared with having no microbleeds, eGFR was lower in those with strictly lobar microbleeds (adjusted mean difference (aMD) -2.10 mL/min/1.73 cm (95% CI -3.39 to -0.81)) and mixed microbleeds (aMD -2.42 (95% CI -3.70 to -1.15)), but not strictly deep microbleeds (aMD -0.67 (95% CI -1.85 to 0.51)).
In patients with IS or transient ischaemic attack, impaired kidney function was associated with a higher risk of recurrent stroke and higher microbleeds burden, compared with those with normal kidney function. Further research is needed to investigate potential additional measures for secondary prevention in this high-risk group.
慢性肾脏病患者发生中风的风险增加，且经常出现脑微出血。此类患者复发性中风的风险是否也会增加尚未得到确凿证实。我们旨在确定肾功能受损是否与复发性中风的风险以及微出血的存在、分布和严重程度相关。
我们使用了来自国际微出血协作网络的汇总数据，以研究肾功能受损（定义为估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²）之间的关联。我们的主要结局是复发性缺血性中风（IS）和颅内出血（ICrH）的复合结局。次要结局包括：（1）主要结局的各个组成部分；（2）根据微出血的存在或抗凝剂的使用对主要结局进行修正；以及（3）微出血的存在、分布和严重程度。
共纳入11175例患者（平均年龄70.7±12.6岁，42%为女性），其中2815例（25.2%）肾功能受损。与eGFR≥60相比，eGFR<60与主要结局的较高风险相关（调整后风险比，aHR 1.33（95%置信区间1.14至1.56），p<0.001）以及复发性IS的较高发生率（aHR 1.33（95%置信区间1.12至1.58））。eGFR降低与ICrH风险无关（aHR 1.07（95%置信区间0.70至1.60））。eGFR还与微出血的存在（调整后比值比，aOR 1.14（95%置信区间1.03至1.26））和严重程度（aOR 1.17（95%置信区间1.06至1.29））相关。与无微出血相比，严格叶性微出血患者的eGFR较低（调整后平均差值，aMD -2.10 mL/min/1.73 cm²（95%置信区间 -3.39至 -0.81）），混合性微出血患者的eGFR也较低（aMD -2.42（95%置信区间 -3.70至 -1.15）），但严格深部微出血患者的eGFR无明显差异（aMD -0.67（95%置信区间 -1.85至0.51））。
在患有IS或短暂性脑缺血发作的患者中，与肾功能正常的患者相比，肾功能受损与复发性中风的较高风险和较高的微出血负担相关。需要进一步研究以探讨针对这一高危人群进行二级预防的潜在额外措施。
