Original Investigation
Pathogenesis and Treatment of Kidney Disease and Hypertension
Silent Cerebral White Matter Lesions and Their Relationship With Vascular Risk Factors in Middle-Aged Predialysis Patients With CKD

https://doi.org/10.1053/j.ajkd.2005.10.029Get rights and content

Background: Silent cerebral white matter lesions are observed on magnetic resonance imaging (MRI) scans in elderly people, and they are related to vascular risk factors, particularly hypertension. No data on the prevalence and risk factors of white matter lesions in patients with chronic kidney disease (CKD) are available. The aim is to analyze the prevalence of white matter lesions and their determinants in this population. Methods: We studied 52 patients without diabetes with CKD (stage 3 or 4) aged 30 to 60 years (average, 49 years) and a group of 32 normotensive control subjects. MRI studies were performed and subcortical and periventricular white matter lesions were evaluated by using semiquantitative measures. Patients were classified into 2 groups depending on the presence or absence of white matter lesions. Echocardiographic studies and measures of markers of systemic inflammation (C-reactive protein and interleukin 6) also were performed. Results: White matter lesions were more prevalent in patients with CKD than controls (33% versus 6%; P = 0.008). Patients with CKD who had white matter lesions were older; had a greater history of cardiovascular disease and vascular nephropathy as a primary cause of renal disease and greater levels of systolic blood pressure, pulse pressure, left ventricular mass index, and C-reactive protein; and were administered more antihypertensive drugs than patients with CKD without white matter lesions. Stage and duration of CKD were not related to the presence of white matter lesions. After adjusting for several factors, only vascular nephropathy (odds ratio, 15.6; 95% confidence interval, 1.27 to 191.54; P = 0.03) independently predicted an increased risk for white matter lesions. Conclusion: One third of middle-aged patients with CKD have silent cerebral white matter lesions. Vascular nephropathy seems to be the most important factor related to the presence of these lesions, suggesting that white matter lesions reflect ischemic brain damage caused by generalized vascular damage.

Section snippets

Study Population

We performed a cross-sectional study of 55 consecutive attending outpatients recruited from the Nephrology Service of the Joan XXIII University Hospital in Tarragona, Spain, and the Nephrology Assistance Unit, Hospital de Jesús, Tortosa, Tarragona. All patients were aged between 30 and 60 years and had CKD, with serum creatinine levels greater than 2.03 mg/dL (>179 μmol/L) and less than 7.91 mg/dL (<699 μmol/L). Exclusion criteria included: (1) diabetes mellitus and (2) clinical evidence of

Patient Characteristics

Three patients with CKD could not be scanned because they reported claustrophobia. Thus, imaging data were available for only 52 patients (38 men, 14 women). Mean age was 49 ± 9 years. The prevalence of white matter lesions was significantly greater in patients with CKD than controls (33% versus 6%; P = 0.008). Incidental findings observed in the MRI analysis of patients with CKD included a small extra-axial meningioma in 1 patient and a small cavernoma in another patient. No patient had a

Discussion

Our study supports the finding that middle-aged predialysis patients with CKD have significantly more silent cerebral white matter lesions than controls. In previous studies, white matter lesions were found in 27% to 87% of populations aged 65 years and older.1, 32 Our patients were selected on the basis of nondiabetic nephropathy as the cause of CKD to exclude the possible effect of diabetes as the predictor of white matter damage and age of 60 years or younger to exclude involutive brain

Acknowledgment

The authors thank Eugenia Masó and Magda Navarro for important cooperation and all the personnel of the magnetic resonance unit for their technical assistance throughout the study.

References (47)

  • J.C. Van Swieten et al.

    Periventricular lesions in the white matter on magnetic resonance imaging in the elderly. A morphometric correlation with arteriosclerosis and dilated periventricular spaces

    Brain

    (1991)
  • L. Pantoni et al.

    Pathogenesis of leukoaraiosis

    Stroke

    (1997)
  • R. Schmidt et al.

    White matter lesion progression. A surrogate endpoint for trials in cerebral small-vessel disease

    Neurology

    (2004)
  • D. Liao et al.

    Presence and severity of cerebral white matter lesions and hypertension. Its treatment, and its control

    Stroke

    (1996)
  • F.E. De Leeuw et al.

    Hypertension and cerebral white matter lesions in a prospective cohort study

    Brain

    (2002)
  • R. Schmidt et al.

    Magnetic resonance imaging signal hyperintensities in the deep and subcortical white matterA comparative study between stroke patients and normal volunteers

    Arch Neurol

    (1992)
  • P. Sachdev et al.

    Homocysteine and the brain in midadult lifeEvidence for an increased risk of leukoaraiosis in men

    Arch Neurol

    (2004)
  • K. Shimada et al.

    Silent cerebrovascular disease in the elderly. Correlation with ambulatory pressure

    Hypertension

    (1990)
  • N.D. Prins et al.

    Cerebral white matter lesions and the risk of dementia

    Arch Neurol

    (2004)
  • J.C. De Groot et al.

    Cerebral white matter lesions and subjective cognitive dysfunction

    Neurology

    (2001)
  • L.H. Kuller et al.

    White matter hyperintensity on cranial magnetic resonance imaging. A predictor of stroke

    Stroke

    (2004)
  • T. Nakatani et al.

    Silent cerebral infarction in hemodialysis patients

    Am J Nephrol

    (2003)
  • G. Leoncini et al.

    Mild renal dysfunction and subclinical cardiovascular damage in primary hypertension

    Hypertension

    (2003)
  • Cited by (0)

    Originally published online as doi:10.1053/j.ajkd.2005.10.029 on January 4, 2006.

    Support: None. Potential conflicts of interest: None.

    View full text