Kidney function changes and their relation with the progression of cerebral small vessel disease and cognitive decline
Kidney function changes and their relation with the progression of cerebral small vessel disease and cognitive decline
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DOI：
10.1016/j.jns.2019.116635
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发表时间：
2020-02-15
影响因子：
4.4
通讯作者：
Delgado, Pilar
中科院分区：
文献类型：
--
作者：
Jimenez-Balado, Joan;Riba-Llena, Iolanda;Delgado, Pilar
目的：我们的目的是研究是否恶化的标志物肾功能平行进展，脑小血管疾病（cSVD）和认知能力下降。方法：数据来自ISWARD（调查无症状中风的高血压研究），一个纵向的人口为基础的研究，在高血压患者年龄在50-70岁，痴呆和中风的基线。在两次访视中，患者均接受脑部MRI、认知诊断（正常老化或轻度认知障碍[MCI]）、尿液和血液采样采集，评估梗死和脑微出血的发生率，以及脑室周围（PVH）和深部白色高信号的进展，测定白蛋白-肌酐比值的变化和估计肾小球滤过率（eGFR）。这些变化在随访时被分为微量白蛋白尿-在有或没有基线微量白蛋白尿的受试者中-和eGFR显著下降-eGFR变化的最低五分位数（-10.57 mL/min/1.73m2）。80例（23%）患者在随访时出现微量白蛋白尿，68例（23%）患者在随访时出现微量白蛋白尿。考虑到cSVD的变化，我们发现随访时微量白蛋白尿与PVH进展之间存在相关性。（β = 0.31，P值= 0.01）。关于认知能力下降，在随访时出现微量白蛋白尿与记忆功能的急剧下降有关（β =-0.36，P值<0.01）。此外，eGFR显著下降的患者发生MCI的风险更高（OR = 3.54，P值= 0.02）。结论：肾功能标志物的恶化与认知功能下降和cSVD的进展有关，这可能与共同的潜在危险因素有关。
Aims: We aimed to study whether worsening in markers of kidney function parallels the progression in cerebral small vessel disease (cSVD) and cognitive decline.Methods: Data from the ISSYS (Investigating Silent Strokes in Hypertensives Study), a longitudinal population-based study in hypertensives aged 50-70 and dementia and stroke-free at baseline. At both visits, patients underwent a brain MRI, a cognitive diagnosis (normal aging or mild cognitive impairment, [MCI]) and urine and blood sampling collection.We assessed the incidence of infarcts and cerebral microbleeds, and the progression of white matter hyper-intensities at periventricular (PVH) and deep areas.We determined changes in albumin-creatinine ratio and estimated glomerular filtration rate (eGFR). These changes were dichotomized into microalbuminuria at follow-up -either in subjects with or without baseline microalbuminuria- and significant decline in eGFR -lowest quintile of eGFR change ( -10.57 mL/min/1.73m(2))-.Results: 360 patients were followed-up for 4 years. 80 (23%) patients presented microalbuminuria at follow-up and 68 (20.1%) experienced a significant eGFR decline.Considering cSVD change, we found a relationship between microalbuminuria at follow-up and progression in PVH (beta = 0.31, P-value = .01).Regarding cognitive decline, presence of microalbuminuria at follow-up related to a steeper decrease in memory function (beta = -0.36, P-value < .01). Moreover, patients with significant decline in eGFR were at higher risk of incident MCI (OR = 3.54, P-value = .02). These associations were independent of progression of cSVD.Conclusion: The worsening in markers of kidney function paralleled the decrease in cognition and the progression of cSVD, and this may be explained by common shared underlying risk factors.