Abstract
Cardiovascular complications, including stroke, may be attributed the highest rate of morbidity and mortality in patients with chronic kidney disease (CKD). The aim of our study was to evaluate the prevalence of CKD in patients with symptomatic ischaemic cerebrovascular disease and to establish of whether CKD may define a particular risk pattern of cerebral vessels modifications in this category of patients. The prevalence of CKD was evaluated in 590 consecutive patients with symptomatic ischaemic cerebrovascular disease admitted to a department of neurology. The types of stroke, the vascular territories, the vascular modifications and the haemodynamic changes (resistance index- RI) found by neurosonology (extracranial and transcranial Doppler ultrasound) were analysed in relation to classic and non-classic cerebrovascular risk factors, as well as to stages of CKD (defined by estimated glomerular filtration rate-eGFR-MDRD4 formula-K/DOQI 2002). The prevalence of CKD in the studied patients was 70.84%. Atherosclerosis in a diffuse pattern was detected in 79.7% of CKD patients, while carotid artery stenoses were found in 10% of cases, occlusions- 5.3%, stenoses + occlusions-1.2%, and multiple stenoses- 3.8% of cases. The RI evaluated in the internal carotid arteries correlated with fibrinogen(P<0.0001) and GFR(P<0.0001), while IR in the middle cerebral arteries correlated with fibrinogen(P<0.05), C-reactive protein(P<0.0001), and GFR(P<0.0001). There is a strong relation between symptomatic cerebrovascular disease and CKD, a fact demonstrated by the increased prevalence of CKD in these patients and by the severity of the cerebral vessels lesions.
[1] Wannamethee SG, Shaper AG, Perry IJ. Serum creatinine concentration and risk of cardiovascular disease: a possible marker of increased risk of stroke. Stroke 1997; 28: 557–563 10.1161/01.STR.28.3.557Search in Google Scholar
[2] Manjunath G, Tighiouart H, Ibrahim H, MacLeod B, Salem DN, Griffith JL et al. Level of kidney function as a risk for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol 2003; 41: 47–55 http://dx.doi.org/10.1016/S0735-1097(02)02663-310.1016/S0735-1097(02)02663-3Search in Google Scholar
[3] Shlipak MG, Fried LF, Crump C, Bleyer AJ, Manolio TA, Tracy RP et al. Cardiovascular disease risk status in elderly persons with renal insufficiency. Kidney Int 2002; 62: 997–1004 http://dx.doi.org/10.1046/j.1523-1755.2002.00522.x10.1046/j.1523-1755.2002.00522.xSearch in Google Scholar PubMed
[4] McCullough PA, Li S, Jurkovitz CT, Stevens LA, Wang C et al. CKD and cardiovascular disease in screened high-risk volunteer and general populations: the Kidney Early Evaluation Programm (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999–2004. Am J Kidney Dis 2008; 51(Suppl2):S38–45 http://dx.doi.org/10.1053/j.ajkd.2007.12.01710.1053/j.ajkd.2007.12.017Search in Google Scholar PubMed
[5] Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J et al. Definition and classification of chronic kidney disease: A position statement from Kidney Disease Improving Outcomes (KDIGO). Kidney Int 2005; 67: 2098–2100 http://dx.doi.org/10.1111/j.1523-1755.2005.00365.x10.1111/j.1523-1755.2005.00365.xSearch in Google Scholar PubMed
[6] Valdueza JM, Schreiber SJ, Roehl JE, Klingebiel R. Neurosonology and neuroimaging of stroke. Georg Thieme Verlag, Stuttgart, 2008 10.1055/b-006-160396Search in Google Scholar
[7] Weiner DE, Tighiouart H, Amin MG, Stark PC, Mac Leod B, Griffith JL et al. Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: A pooled analysis of community-based studies. J Am Soc Nephrol 2004; 15: 1307–1315 http://dx.doi.org/10.1097/01.ASN.0000123691.46138.E210.1097/01.ASN.0000123691.46138.E2Search in Google Scholar
[8] Koren-Morag N, Goldbourt U, Tanne D. Renal dysfunction and risk of ischemic stroke or TIA in patients with cardiovascular disease. Neurology 2006; 67:224–228 http://dx.doi.org/10.1212/01.wnl.0000229099.62706.a310.1212/01.wnl.0000229099.62706.a3Search in Google Scholar PubMed
[9] Ikram MA, Vernooij MW, Hofman A, Niessen WJ, van der Lugt A, Breteler MMB. Kidney function is related to cerebral small vessel disease. Stroke 2008; 39: 55–61 http://dx.doi.org/10.1161/STROKEAHA.107.49349410.1161/STROKEAHA.107.493494Search in Google Scholar PubMed
[10] Rahn KH, Barenbrock M, Hausberg M, Kosch M, Suwelack B, Witt J. Vessel wall alterations in patients with renal failure. Hypertens Res. 2000; 23: 3–6 http://dx.doi.org/10.1291/hypres.23.310.1291/hypres.23.3Search in Google Scholar PubMed
[11] Shinohara K, Shoji T, Tsujimoto Y, Kimoto E, Tahara H, Koyama H et al. Arterial stiffness in predialysis patients with uremia. Kidney Int 2004; 65: 936–943 http://dx.doi.org/10.1111/j.1523-1755.2004.00468.x10.1111/j.1523-1755.2004.00468.xSearch in Google Scholar PubMed
[12] Shoji T, Emoto M, Tabata T, Kimoto E, Shinohara K, Maekawa K et al. Advanced atherosclerosis in predialysis patients with chronic renal failure. Kidney Int 2002; 61: 2187–2192 http://dx.doi.org/10.1046/j.1523-1755.2002.00372.x10.1046/j.1523-1755.2002.00372.xSearch in Google Scholar PubMed
[13] Toyoda K, Kumai Y, Fujii K, Ibayashi S, Iida M. Transcranial color-coded sonography for vertebrobasilar disorders in end-stage renal disease. J Neurol Sci 2005; 232:77–81 http://dx.doi.org/10.1016/j.jns.2005.01.01510.1016/j.jns.2005.01.015Search in Google Scholar PubMed
[14] Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM. Arterial calcifications, arterial stiffness and cardiovascular risk in end-stage renal disease. Hypertension 2001; 38: 938–942 http://dx.doi.org/10.1161/hy1001.09635810.1161/hy1001.096358Search in Google Scholar PubMed
[15] Mourad JJ, Pannier B, Blacher J, Rudnichi A, Benetos A, London GM et al. Creatinine clearance, pulse wave velocity, carotid compliance and essential hypertension. Kidney Int 2001; 59: 1834–1841 http://dx.doi.org/10.1046/j.1523-1755.2001.0590051834.x10.1046/j.1523-1755.2001.0590051834.xSearch in Google Scholar PubMed
[16] Groothoff JW, Gruppen MP, Offringa M, DE Groot E, Stok W, Bos WJ et al. Increased arterial stiffness in young adults with end-stage renal disease since childhood. J Am Soc Nephrol 2002; 13:2953–2961 http://dx.doi.org/10.1097/01.ASN.0000037677.16961.DF10.1097/01.ASN.0000037677.16961.DFSearch in Google Scholar PubMed
[17] Petrica L, Petrica M, Schiller A, Velciov S, Gluhovschi Gh, Trandafirescu V et al. Asymptomatic carotid artery stenosis in patients with primary chronic glomerulonephritis. Facta Universitatis Nis, series Medicine and Biology, 2000; 7: 116–123 Search in Google Scholar
[18] Petrica L, Petrica M, Bob F, Gluhovschi C, Jianu C, Gluhovschi Gh et al. Particular aspects of cerebral haemodynamics in patients with chronic renal failure. Nefrologia 2004; 9: 215–224 Search in Google Scholar
[19] Tkac I, Troscak M, Javorsky M, Petrik R, Tomcova M. Increased intracranial arterial resistance in patients with type 2 diabetes mellitus. Wien Klin Wochenschr 2001; 113: 870–873 Search in Google Scholar
[20] Lee KY, Young HS, Baik JS, Kim GW, Kim JS. Arterial pulsatility as an index of cerebral microangiopathy in diabetes. Stroke 2000; 31:1111–1115 10.1161/01.STR.31.5.1111Search in Google Scholar PubMed
[21] Petrica L, Petrica M, Munteanu M, Vlad A, Bob F, Gluhovschi C et al. Cerebral microangiopathy in patients with non-insulin-dependent diabetes mellitus. Ann Acad Med Singapore 2007; 36: 259–266 10.47102/annals-acadmedsg.V36N4p259Search in Google Scholar
[22] Petrica L, Petrica M, Vlad A, Bob F, Gluhovschi C, Gluhovschi Gh et al. Cerebrovascular reactivity is impaired in patients with non-insulin-dependent diabetes mellitus and microangiopathy. Wien Klin Wochenschr 2007; 119:365–371 http://dx.doi.org/10.1007/s00508-007-0809-010.1007/s00508-007-0809-0Search in Google Scholar PubMed
[23] Kuroda S, Nishida N, Uzu T, Takeji M, Nishimura M, Fujii T et al. Prevalence of renal artery stenosis in autopsy patients with stroke. Stroke 2000; 31: 61–65 10.1161/01.STR.31.1.61Search in Google Scholar
[24] Seliger SL, Longstreth WT. Lessons about brain vascular disease from another pulsating organ, the kidney. Stroke 2008; 39: 5–6 http://dx.doi.org/10.1161/STROKEAHA.107.49600010.1161/STROKEAHA.107.496000Search in Google Scholar PubMed
[25] Rossi A, Bonfante L, Giacomini A, Calabro A, Rossi G, Saller A et al. Carotid artery lesions in patients with nondiabetic chronic renal failure. Am J Kidney Dis 1996; 27: 58–66 http://dx.doi.org/10.1016/S0272-6386(96)90031-110.1016/S0272-6386(96)90031-1Search in Google Scholar
[26] Kawagishi T, Nishizawa Y, Konishi T, Kawasaki K, Emoto M, Shoji T et al. High resolution B-mode ultrasonography in evaluation of atherosclerosis in uremia. Kidney Int 1995; 48: 820–826 http://dx.doi.org/10.1038/ki.1995.35610.1038/ki.1995.356Search in Google Scholar
[27] Savage T, Clarke AL, Giles M, Tomson CRV, Raine AEG. Calcified plaque is common in the carotid and femoral arteries of dialysis patients without clinical vascular disease. Nephrol Dial Transplant 1998; 13: 2004–2012 http://dx.doi.org/10.1093/ndt/13.8.200410.1093/ndt/13.8.2004Search in Google Scholar
[28] Mikovanov IS, Dzitoeva MI, Shilov EM, Safonov VV, Brazhnik VA, Savina LN. Atherosclerosis/calcinosis of the carotid and peripheral arteries in patients with initial and terminal stages of chronic renal failure. Ter Arkh 2006; 78:55–59 Search in Google Scholar
[29] Pascazio L, Bianco F, Giorgini A, Galli G, Curri G, Panzetta G. Echo color Doppler imaging of carotid vessels in hemodialysis patients: evidence of high level of atherosclerotic lesions. Am J Kidney Dis 1996; 28: 713–720 http://dx.doi.org/10.1016/S0272-6386(96)90253-X10.1016/S0272-6386(96)90253-XSearch in Google Scholar
[30] New DI, Chesser AM, Thuraisingham RC, Yaqoob MM. Structural remodeling of resistance arteries in uremic hypertension. Kidney Int 2004; 65: 1818–1825 http://dx.doi.org/10.1111/j.1523-1755.2004.00591.x10.1111/j.1523-1755.2004.00591.xSearch in Google Scholar PubMed
[31] Kobayashi M, Hirawa N, Yatsu K, Kobayashi Y, Yamamoto Y, Saka S et al. Relationship between silent brain infarction and chronic kidney disease. Nephrol Dial Transplant 2009; 24: 201–207 http://dx.doi.org/10.1093/ndt/gfn41910.1093/ndt/gfn419Search in Google Scholar PubMed PubMed Central
[32] Preston E, Ellis MR, Kulinskaya E, Davies AH, Brown EA. Association between carotid artery intima-media thickness and cardiovascular risk factors in CKD. Am J Kidney Dis 2005; 46: 856–862 http://dx.doi.org/10.1053/j.ajkd.2005.07.04810.1053/j.ajkd.2005.07.048Search in Google Scholar PubMed
[33] Verhave JC, Hillege HL, Burgerhof JGM, Gansevoort RT, De Zeeuw D, De Jong PE, for the PREVEND Study Group. The association between atherosclerotic risk factors and renal function in the general population. Kidney Int 2005; 67: 1967–1973 http://dx.doi.org/10.1111/j.1523-1755.2005.00296.x10.1111/j.1523-1755.2005.00296.xSearch in Google Scholar PubMed
[34] Menon V, Greene T, Wang X, Pereira AA, Marcovina SM, Beck GJ et al. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int 2005; 68:766–772 http://dx.doi.org/10.1111/j.1523-1755.2005.00455.x10.1111/j.1523-1755.2005.00455.xSearch in Google Scholar PubMed
[35] Kobayashi S, Ikeda T, Moriya H, Ohtake T, Kumagai H. Asymptomatic cerebral lacunae in patients with chronic kidney disease. Am J Kidney Dis 2004; 44: 33–41 http://dx.doi.org/10.1053/j.ajkd.2004.03.02610.1053/j.ajkd.2004.03.026Search in Google Scholar PubMed
[36] Pontremoli R, Leoncini G, Ravera M, Viazzi F, Vettoretti S, Ratto E et al. Microalbuminuria, cardiovascular, and renal risk in primary hypertension. J Am Soc Nephrol 2002; 13: S169–S172 http://dx.doi.org/10.1097/01.ASN.0000032601.86590.F710.1097/01.ASN.0000032601.86590.F7Search in Google Scholar PubMed
[37] Tkac I, Silver F, Lamarache B, Lewis GF, Steiner G. Serum creatinine level is an independent risk factor for the angiographic severity of internal carotid artery stenosis in subjects who have previously had transient ischaemic attacks. J Cardiovasc Risk 1998; 5: 79–83 http://dx.doi.org/10.1097/00043798-199804000-0000210.1097/00043798-199804000-00002Search in Google Scholar
[38] Irie F, Iso H, Sairenchi T, Fukasawa N, Yamagishi K, Ikehara S et al. The relationship of proteinuria, serum creatinine, glomerular filtration rate with cardiovascular disease mortality in Japanese general population. Kidney Int 2006; 69: 1264–1271 http://dx.doi.org/10.1038/sj.ki.500028410.1038/sj.ki.5000284Search in Google Scholar PubMed
[39] Seliger SL, Gillen DL, Longstreth WT, Kestenbaum B, Stehman-Breen CO. Elevated risk of stroke among patients with end-stage renal disease. Kidney Int 2003; 64: 603–609 http://dx.doi.org/10.1046/j.1523-1755.2003.00101.x10.1046/j.1523-1755.2003.00101.xSearch in Google Scholar PubMed
[40] Metivier F, Marchais SJ, Guerin AP, Pannier B, London GM. Pathophysiology of anemia: focus on the heart and blood vessels. Nephrol Dial Transplant 2000; 15[3 Suppl]: 14–18 10.1093/oxfordjournals.ndt.a027970Search in Google Scholar PubMed
[41] Abramson JL, Jurcovitz CT, Vaccarino V, Weintraub WS, McClellan W. Chronic kidney disease, anaemia, and incident stroke in a middle-aged, community-based population: The ARIC Study. Kidney Int 2003; 64:610–615 http://dx.doi.org/10.1046/j.1523-1755.2003.00109.x10.1046/j.1523-1755.2003.00109.xSearch in Google Scholar PubMed
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