Key result
In post-stroke patients, chronic kidney disease was associated with higher anterior cerebral artery pulsatility index (median 1.2 vs 0.91, p<0.0001) and greater MRI small vessel disease burden.
Why the study?
Chronic kidney disease independently increases the risk of stroke and small vessel disease, motivating an evaluation of its impact on intracranial vascular resistance and small vessel disease in post-stroke patients.
Does chronic kidney disease increase intracranial vascular resistance and small vessel disease burden in post-stroke patients?
Observational (n=118)
Does chronic kidney disease increase intracranial vascular resistance and small vessel disease burden in post-stroke patients?
Absolute Event Rate: 1.2% vs 0.91%
p-value: p=<0.0001
In post-stroke patients, chronic kidney disease is independently associated with increased intracranial vascular resistance and greater small vessel disease burden.
Chronic kidney disease (CKD) independently increases the risk of stroke and small vessel disease (SVD). This study compared SVD and a transcranial Doppler (TCD)-based marker of intracranial vascular resistance (pulsatility index, PI) in post-stroke patients with and without CKD. Between January 2015 and December 2017, 118 individuals with stable eGFR (50 with CKD) had cerebral MRI and TCD within three months of a stroke. The means of bilateral PI in anterior (anterior cerebral [ACA] and middle cerebral arteries [MCA]) and posterior vessels (posterior cerebral [PCA] and vertebral arteries [VA]) were computed. CKD strongly correlated with higher distal resistance (median CKD ACA PI 1.2, IQR 1.0 to 1.35 vs. controls 0.91 IQR 0.79 to 1.1 [ p < 0.0001]; median MCA PI 1.14 IQR 1.03 to 1.39 vs. controls 0.93 IQR 0.79 to 1.1 [ p < 0.0001]) and MRI SVD burden (median CKD SVD 4.98 × 10 4 IQR 2.66 to 7.76 × 10 4 voxels vs. controls median SVD 6.7 × 10 3 IQR 2.4 to 24.0 × 10 3 [ p < 0.0001]). In conclusion, in patients with recent stroke, CKD is an independent determinant of increased intracranial vascular resistance in both anterior and posterior cerebral circulations. MRI SVD volume is significantly associated with anterior and posterior circulation PI.
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Ghoshal et al. (2019) conducted an observational in Post-stroke (n=118). Chronic kidney disease (CKD) vs. Without CKD (controls) was evaluated on Anterior cerebral artery pulsatility index (ACA PI) (p=<0.0001). In post-stroke patients, chronic kidney disease was associated with higher anterior cerebral artery pulsatility index (median 1.2 vs 0.91, p<0.0001) and greater MRI small vessel disease burden.
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