1389-P: DKD Independently Predicts Cerebral Small Vessel Disease in T2DM: Focus on White Matter Hyperintensity and Cerebral Microbleeds

Introduction and Objective: Cerebral small vessel disease (CSVD) is a major microvascular complication of type 2 diabetes mellitus (T2DM), contributing to cognitive decline and stroke. Its association with diabetic kidney disease (DKD), a key peripheral microangiopathy, remains insufficiently investigated. This study aimed to systematically investigate the relationship between DKD and CSVD in patients with T2DM. Methods: In this cross-sectional study, 136 patients with T2DM were enrolled. CSVD total burden (0-4 points) and components—white matter hyperintensity (WMH), lacune, cerebral microbleed (CMB), perivascular spaces—were assessed on brain MRI according to STRIVE-2 criteria. DKD was defined based on albuminuria and/or reduced estimated glomerular filtration rate (eGFR). Multivariable logistic regression was used to identify independent risk factors. Associations between CSVD and renal injury were assesed using spearman correlation. Results: Compared to patients without CSVD (n=48), those with CSVD (n=88) were older, had longer diabetes duration, and exhibited worse renal function. After adjusting for confounders, DKD remained an independent risk factor for CSVD (adjusted odds ratio [OR]=3.18, 95% CI: 1.23-8.25, P=0.017). CSVD total burden correlated positively with albuminuria stage (ρ=0.278, P=0.001), eGFR stage (ρ=0.244, P=0.004), and KDIGO risk category (ρ=0.260, P=0.002). Component analysis revealed that WMH and CMB were significantly associated with renal injury indices, whereas lacunes and perivascular spaces were not. Conclusion: DKD is an independent predictor of CSVD in T2DM, indicating parallel progression of microvascular injury. WMH and CMB are specific brain imaging markers closely linked to kidney damage. These findings provide direct evidence for brain-kidney crosstalk and support integrated assessment in T2DM management. Disclosure X. Wu: None. T. Hou: None. S. Zhou: None. C. Zong: None. Y. Song: None. J. Zhang: None. C. Yan: None. Funding Medical and Health Science Program of Zhejiang Province (WKJ-ZJ-26002)