Kidney Function Tied to Small Vessel Disease Marker

TOPLINEGlomerular hyperfiltration was independently associated with enlarged perivascular spaces (EPVS) in both the basal ganglia and centrum semiovale among patients with ischemic stroke or transient ischemic attack (TIA), while impaired kidney function showed no such association. Severe kidney impairment (estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2) was modestly associated with overall cerebral small vessel disease (cSVD) burden, but hyperfiltration was not.METHODOLOGYA cross-sectional analysis of baseline data from the Microbleeds International Collaborative Network included 7254 adults with ischemic stroke or TIA (mean age, 70.8 years; 42.9% women) from multiple international centers.Participants were categorized by kidney function: hyperfiltration (eGFR above the age- and sex-adjusted 95th percentile; n = 357), normofiltration (n = 4949), eGFR 30-60 mL/min/1.73 m2 (n = 1692), and eGFR <30 mL/min/1.73 m2 (n = 256).Primary outcomes were EPVS severity in the basal ganglia and centrum semiovale, assessed using a validated visual rating scale; secondary outcomes included combined cSVD burden score and individual cSVD markers (white matter hyperintensities, lacunes, cerebral microbleeds [CMB]).The associations of impaired kidney function and glomerular hyperfiltration with the presence and severity of EPVS and overall cSVD burden were adjusted for age, sex, East Asian study center, hypertension, diabetes, ischemic heart disease, smoking, and hypercholesterolemia.TAKEAWAYCompared with normofiltration, hyperfiltration was independently associated with more severe basal ganglia EPVS (adjusted odds ratio [aOR], 1.38; P = .003) and centrum semiovale EPVS (aOR, 1.34; P = .006).Reduced eGFR (30-60 mL/min/1.73 m2 or <30 mL/min/1.73 m2) showed no significant association with EPVS severity in either brain region after adjustment.Severe kidney impairment (eGFR <30 mL/min/1.73 m2) was modestly associated with higher combined cSVD burden score (aOR, 1.27; P = .025), while hyperfiltration showed no significant association (P = .087).Hyperfiltration was associated with lower CMB presence compared with normofiltration (26.2% vs 31.2%).IN PRACTICE"It is not straightforward to explain why EPVS were associated with glomerular hyperfiltration, an early marker of kidney dysfunction, and not overt reduced eGFR. As EPVS are cSVD manifestations which appear relatively early in the disease process, it is possible that this reflects the earlier development of glomerular hyperfiltration in the natural history of microvascular kidney and cerebral damage," wrote the authors of the study.SOURCEThe study was led by Philip S. Nash, University College London Queen Square Institute of Neurology in London. It was published online on August 4 in Neurology.LIMITATIONSThe observational design cannot exclude residual confounding. Kidney function was assessed from a single blood test at stroke onset, potentially including cases of acute kidney injury and introducing measurement error. Data on albuminuria and BMI were unavailable, precluding adjustment for these important confounders. EPVS assessment relied on visual rating scores rather than volumetric quantification, which may have limited sensitivity.DISCLOSURESThe study was supported by the UCL Hospitals Stroke Charity Fund and the Michael Feldman and The Lady Estelle Wolfson Bursary Fund held at UCL Hospitals Charitable Foundation. The authors reported no conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.