The Burden of Occult Cerebrovascular Disease in CKD: A Scoping Review

Rationale & Objective Occult cerebrovascular diseases (OCCD) including extracranial and intracranial atherosclerotic disease (ECAD and ICAD) and cerebral small vessel disease (CSVD) are asymptomatic cerebrovascular abnormalities associated with future risk of stroke and dementia. Although chronic kidney disease (CKD) is strongly associated with adverse brain health outcomes, the breadth of evidence regarding OCCD in people with CKD has not been comprehensively characterized. This scoping review summarizes the available literature on OCCD among adults with CKD without clinically overt cerebrovascular disease. Sources of Evidence PubMed, EMBASE, Web of Science, and Scopus were searched for studies published between January 2000 and July 2025. Eligibility Criteria Peer-reviewed studies reporting the frequency or characteristics of OCCD manifestations in adults with CKD without a known history of stroke or transient ischemic attack. Charting Methods Two reviewers independently screened studies and extracted data on study characteristics, CKD definitions, neuroimaging modalities, and reported OCCD findings. Methodological quality was assessed using a modified Newcastle–Ottawa Scale. Results Forty-six studies comprising 5,153 participants with CKD were included. Study populations varied substantially with respect to CKD stage, dialysis status, study design, and imaging methodology. Two studies evaluating ICAD reported moderate-to-severe intracranial stenosis in approximately one-quarter of participants with CKD. Across studies evaluating ECAD, the frequency of significant extracranial carotid stenosis ranged from approximately 3% in patients with non–dialysis-dependent CKD to 28% among patients receiving dialysis. Thirty-eight studies evaluated manifestations of CSVD, including cerebral microbleeds, silent cerebral infarctions, white matter hyperintensities, and enlarged perivascular spaces. Several studies suggested a greater burden of CSVD manifestations among patients with advanced CKD or dialysis dependence. Reported frequencies varied considerably across studies. Limitations Considerable heterogeneity in study populations, CKD definitions, imaging protocols, and outcome ascertainment methods limited direct comparison across studies. Conclusions Occult cerebrovascular abnormalities are frequently reported across diverse CKD populations, particularly among patients with advanced kidney disease. Variation in the prevalence of abnormalities may reflect differences in CKD severity, participant characteristics, neuroimaging protocols, and outcome definitions. These findings highlight the need for standardized neuroimaging approaches and prospective studies to better characterize the clinical implications of OCCD in CKD.