Abstract 3280: Cystatin C, a Novel Indicator of Kidney Function, Reflects Severity of Cerebral Small Vessel Disease
Background: Recent studies reported that lacunar infarction, white mater lesions (WMLs) and microbleeds (MBs) might be associated with kidney disease. Cystatin C is, competitive inhibitors of lysosomal cysteine protease, suggested to be a more accurate and sensitive indicator of kidney function, compared to creatinine, creatinine based estimated glomerular filtration rate (GFR). We investigated whether Cystatin C might reflect the severity of cerebral small disease.
Methods: Data prospectively collected on subjects with ischemic stroke or transient ischemic attack to a university medical center was analyzed between January 2008 and May 2011. The severity of WMLs was rated using visual rating scale: normal, no lesion or single one, moderate, multiple focal lesion, extensive, multiple confluent lesion scattered throughout white mater. That of MBs was graded according to the number of MB: normal, absence of MB, mild, 1-4, moderate, 5-9, severe, ≥10. GFR were classified to four categories based on the chronic kidney disease criteria. Multivariable ordinal logistic regression analysis, adjusted confounders-age, gender, hypertension, diabetes, hyperlipidemia, smoking, history of stroke, heart disease and total cholesterol, was performed to determine the association between Cystatin C and severity of small vessel disease.
Results: A total of 699 subjects were enrolled in this study. Subjects with more severe small vessel disease were likely to be older, have hypertension and history of stroke. The proportion of higher grade of WMLs and MBs was increased according to quartiles of Cystatin C. Compared to lowest quartiles(<47.2 nmol/L), higher Cystatin C quartiles (47.2 -54.7, 54.7-65.7, 65.7≥nmol/L) were likely to have more severe WML grades. [Adjusted OR (95%CI), 1.38(0.93, 2.04), 2.67( 1.81, 3.95), 3.32(2.23, 4.93)]. In addition, higher Cystatin C quartiles tended to have more severe MB grades [adjusted OR (95%CI), 0.98(0.61, 1.51), 1.57(1.00, 2.44), 2.19(1.40, 3.40)]. Compared to the lowest categories of estimated GFR (≥60 ml/min/1.73m2), higher categories of estimated GFR(45.0- 60.0, 15.0-45.0, ≤15.0 ml/min/1.73m2) did not show significant association with the grades of small vessel disease.
Conclusion: Vascular beds of brain and kidney had similar characteristics. Patients with impaired kidney function would have also cerebral small vessel disease. Cystatin C is more accurate indicator of kidney function to detect subclinical kidney disease. In this present study, Serum Cystatin C reflects severity of cerebral small vessel disease, independent of estimated GFR.
- © 2012 by American Heart Association, Inc.