Correlation Study Of Risk Factors For White Matter Lesions In Stage 5 Patients With Chronic Kidney Disease

Background: Chronic kidney disease(CKD)is considered one of the major public health problems facing humanity in the 21 st century,with a significant increase in teratogenic mortality in CKD stage 5,or end-stage renal disease(ESRD).Stroke is the third leading cause of death in CKD patients,and ESRD patients have up to 10 times the risk of hospitalization due to stroke.Patients with white matter lesions(WML)have a 3-fold increased risk of stroke and a 2-fold increased risk of death.Some studies suggest that WML is more common in ESRD patients.As a result,ESRD patients have an increased risk of stroke and a higher mortality rate.Until now,very few studies have been reported on the correlation of risk factors for WML in ESRD patients in China and abroad.Objective:We analyzed and investigated the risk factors for the development of WML in ESRD patients and the correlation between each index and the severity of WML,and searched for the predictors of WML in ESRD patients by multivariate logistic regression model ROC curves.The aim was to prevent and/or delay the development of WML by actively controlling the risk factors of WML;to reduce the occurrence of WML-induced stroke,and thus to reduce the morbidity and mortality of ESRD patients who died from stroke.Methods : A retrospective study was conducted to collect 176 patients admitted to Gansu Provincial People’s Hospital between January 2017 and January 2021 who met the diagnostic criteria of chronic kidney disease stage 5 and underwent cranial MRI examination.According to Fazekas classification,they were divided into 73 cases in the group without cerebral white matter lesions(WML0),103 cases in the group with cerebral white matter lesions(WML),and the WML group including 38 cases in the mild group(WML1),34 cases in the moderate group(WML2),and 31 cases in the severe group(WML3).The clinical data(gender,age,body mass index,smoking history,drinking history,hypertension,diabetes mellitus,age of kidney disease,etc.),laboratory examination data(blood routine,liver and kidney function,electrolytes,lipids,thyrotropin,complement and other test indexes)and head MRI imaging data(Fazekas classification,lacunar cerebral infarction)of each patient were collected.SPSS20.0 statistical software was used to analyze the risk factors of WML in ESRD patients and the correlation between each index and the severity of WML,and to find the predictors of WML in ESRD patients by multivariate logistic regression model ROC curve.Results:1.The proportion of WML in different subgroups was divided into 73 cases in the no cerebral white matter lesion group(WML0)and 103 cases in the cerebral white matter lesion group(WML)according to Fazekas classification,and the proportion of WML was 58.5%.According to whether dialysis was performed or not,there were 75 cases in the non-dialysis group and 101 cases in the dialysis group,and the proportion of WML was 56.0% and 60.4%,respectively;among them,the proportion of WML in hemodialysis patients was 59.6% and the proportion of WML in peritoneal dialysis patients was 61.1%.2.There were statistically significant differences in the proportion of men,proportion of hypertensive disease,proportion of diabetes mellitus,age,systolic blood pressure,erythrocyte sedimentation rate,blood creatinine,blood phosphorus,complement C4,and prothrombin time in patients with stage 5 CKD without WML compared with the WML group(P < 0.05).3.The comparison of general information between groups with different grades of WML in patients with CKD stage 5 showed statistically significant differences(P < 0.05)in males,history of smoking,history of alcohol consumption,hypertensive disease,diabetes mellitus,lacunar cerebral infarction,age,and T3 between the four groups.With the increase of WML grade,the proportion of lacunar cerebral infarction and age increased;the proportion of males,the proportion of smoking history,the proportion of drinking history,the proportion of hypertensive disease,and the proportion of diabetes mellitus showed an overall increasing trend,and the T3 level showed an overall decreasing trend.4.Multiple correlation analysis showed that the severity of WML in patients with CKD stage 5 was positively correlated with age,smoking history,hypertensive disease,diabetes mellitus,and lacunar cerebral infarction,and negatively correlated with male,blood creatinine,blood phosphorus,T3,and prothrombin time,(P < 0.05).5.Multiple logistic regression analysis showed that male,age,systolic blood pressure,erythrocyte sedimentation rate,and complement C4 were independent risk factors for WML in patients with stage 5 CKD.6.Predictive value: age,male,systolic blood pressure,and area under the complement C4 curve(AUC)were 0.799,0.632,0.599,and 0.590,respectively,(P < 0.05)in patients with stage 5 CKD complicated by WML;the erythrocyte sedimentation rate AUC was 0.571,(P >0.05).It is suggested that age,male,systolic blood pressure,and complement C4 have predictive value for WML in patients with CKD stage 5.Conclusion:The prevalence of cerebral white matter lesions is significantly higher in patients with CKD stage 5,and the associated risk factors are diabetes mellitus,low blood creatinine,high blood phosphorus,low erythrocyte sedimentation rate,and prothrombin time.Advanced age,high systolic blood pressure,and low complement C4 were independent risk factors for WML.Age,systolic blood pressure,and complement C4 may have predictive value for cerebral white matter lesions in patients with CKD stage 5.