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(Stroke. 2008;39:55.)
© 2008 American Heart Association, Inc.

Original Contributions

Kidney Function Is Related to Cerebral Small Vessel Disease

M. Arfan Ikram, MD; Meike W. Vernooij, MD; Albert Hofman, MD, PhD; Wiro J. Niessen, PhD; Aad van der Lugt, MD, PhD Monique M.B. Breteler, MD, PhD

From the Departments of Epidemiology & Biostatistics (M.A.I., M.W.V., A.H., M.M.B.B.), Radiology (M.W.V., W.J.N., A.v.d.L.), and Medical Informatics (W.J.N.), Erasmus Medical Center, The Netherlands.

Correspondence to M.M.B. Breteler, MD, PhD, Department of Epidemiology & Biostatistics, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. E-mail m.breteler{at}erasmusmc.nl

Background and Purpose— Poor kidney function, as measured by glomerular filtration rate (GFR), is closely associated with presence of glomerular small vessel disease. Given the hemodynamic similarities between the vascular beds of the kidney and the brain, we hypothesized an association between kidney function and markers of cerebral small vessel disease on MRI. We investigated this association in a population-based study of elderly persons.

Methods— We measured GFR using the Cockcroft-Gault equation in 484 participants (60 to 90 years of age) from the Rotterdam Scan Study. Using automated MRI-analysis we measured global as well as lobar and deep volumes of gray matter and white matter, and volume of WML. Lacunar infarcts were rated visually. Volumes of deep white matter and WML and presence of lacunar infarcts reflected cerebral small vessel disease. We used linear and logistic regression models to investigate the association between GFR and brain imaging parameters. Analyses were adjusted for age, sex, and additionally for cardiovascular risk factors.

Results— Persons with lower GFR had less deep white matter volume (difference in standardized volume per SD decrease in GFR: –0.15 [95% CI –0.26 to –0.04]), more WML (difference per SD decrease in GFR: 0.14 [95% CI 0.03 to 0.25]), and more often lacunar infarcts, although the latter was not significant. GFR was not associated with gray matter volume or lobar white matter volume. Additional adjustment for cardiovascular risk factors yielded similar results.

Conclusions— Impaired kidney function is associated with markers of cerebral small vessel disease as assessed on MRI.

Key Words: brain • epidemiology • glomerular filtration rate • magnetic resonance imaging • small vessel disease

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