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Abstract: TH-PO679

MRI Markers of Cerebral Small Vessel Disease in CKD Patients with TIA and Minor Stroke

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Kelly, Dearbhla, University of Oxford, Oxford, United Kingdom
  • Rothwell, Peter M., University of Oxford, Oxford, United Kingdom

Group or Team Name

  • on behalf of the Oxford Vascular Study
Background

It has been hypothesized that cerebral small vessel disease (SVD) and CKD may be part of a multi-system vasculopathy, but their association may simply be as a result of shared risk factors (eg, hypertension).

Methods

In a population-based study of transient ischemic attack and ischemic stroke (OXVASC), we evaluated the MRI markers of cerebral SVD, including lacunes, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular space. We studied the age-specific associations of CKD and total SVD burden (total SVD score) adjusting for age, sex, vascular risk factors, and premorbid blood pressure (mean blood pressure during 20 years pre-event).

Results

1718 patients had complete magnetic resonance imaging protocol and creatinine measured at baseline. CKD was associated with total SVD score (odds ratio [OR], 2.83; 95% confidence interval [CI], 2.28–3.53; P<0.001), but mainly at age <60 years (<60 years: OR, 8.43; 95% CI, 3.12-22.78; P<0.001; 60–79 years: OR, 1.38; 95% CI, 1.02–1.87; P=0.038; ≥80 years: OR, 1.09; 95% CI, 0.74–1.6; P=0.676). The overall association of renal impairment and total SVD score was also attenuated after adjustment for age, sex, history of hypertension, and diabetes mellitus (adjusted OR, 1.05; 95% CI, 0.83–1.34; P=0.67), but the independent association of renal impairment and total SVD score at age <60 years was maintained (adjusted OR, 6.07; 95% CI, 2.22–16.59; P=<0.001). Associations of renal impairment and SVD were consistent for each SVD marker at age <60 years but were strongest for cerebral microbleeds (OR, 9.04; 95% CI, 2.76–29.61; P<0.001) and moderate–severe periventricular white matter hyperintensities (OR, 6.67; 95% CI, 1.95–22.86; P=0.003).

Conclusion

The association of CKD and cerebral SVD was attenuated with adjustment for shared risk factors at older ages, but remained at younger ages, consistent with a shared susceptibility, likely at a genetic level, to premature disease.