Association Between Chronic Kidney Disease And Cerebral Microbleeds In Patients With Ischemic Stroke

ObjectiveTo investigate the rate of cerebral microbleeds and risk factors in patients with ischemic stroke using susceptibility weighted imaging and to explore the association between chronic kidney disease and cerebral microbleeds in patients with ischemic stroke.Evaluating the feasibility of chronic kidney disease、proteinuria as predictor of ischemic cerebral stroke.Methods:Totally 242 first-time-attack ischemic stroke patients were selected in the study and susceptibility weighted imagings were performed to determine whether the microbleed occurs in cerebral infarction area in 2 weeks after admission.The microbleed was evaluated by microbleed anatomical rating scale. Glomerular filtration rate estimated value(e GFR) were calculated for all patients.Prevalence,classification and grading of cerebral microbleeds and chronic kidney disease were collected. Relevant factors of brain microbleeds and the association with chronic kidney disease were analyzed.Single risk factor’s feasibility as predictor of cerebral microbleeds in patients with ischemic stroke was tested.Results:1、There were 118 cases with cerebral microbleeds in 242 cases, the prevalence was 48.76%.There were 38 cases in stage1(CMBs n=1-3),which accounted for 32.20% of the CMBs group; 58 cases in stage2(CMBs n=4-10),which accounted for 49.15% of the CMBs group;22cases in stage3(CMBs n>10),which accounted for 18.64% of the CMBs group.2、There were 746 CMBs in 118 cases with cerebral microbleeds.CMBs mainly focused in deep gray matter area and infratentorial area(335/746,44.92% and 226/746,35.59%);then in corticosubcortical area(145/746,19.49%).3、There were no signifcant difference in history of sex、smoking、hyperlipidemia and diabetes between the ischemic stroke patients with or without CMBs.Venerable age(≥55),hypertension, proteinuria and CKD of patients with ischemic stroke were significantly correlated with cerebral microbleeds by univariate analysis which could be act as risk factors.The e GFR in CMBs group was significantly lower than that without CMBs group(t=2.0816,P<0.05)4、Glomerular filtration rate estimated value(e GFR)was much more higher in ischemic stroke with CMBs than that without CMBs(t=2.0816,P<0.05).5、ROC curve analysis indicate that CKD levels could be a potential marker for predict of CMBs in ischemic stroke patients.Venerable age(≥55),hypertension, proteinuria and CKD levels could predicte 58.7% 、 60.2% 、 61.7% 、 70.9% of the total cases respectively,which indicated that they would be potential usefull risk warning biomarkers.6、Diagnosis model consist of three risk factors(venerable age(≥55),hypertension, proteinuria and CKD levels) could predicte75.61% of the total cases,which was higher than single risk factor,while with a poor accuracy of prediction with CMBs group(64.4%). The accuracy of prediction was greatly improved by the diagnosis model consist of four risk factors including proteinuria,which could predicte 85.9% of the total cases(with proper diagnostic accuracy of 86.4% and 85.5% between the ischemic stroke patients with or without CMBs).7 、 There were 71 CKD(which e GFR were lower than 60 m L·min-1·(1.73 m2)-1)patients, the CKD prevalence was29.33%.There were 17 patients in CKD stage 2(25.35%),28 patients in CKD stage 3(38.03%) and 26 patients in CKD stage 4(36.62%).8、There were 49 cases with cerebral microbleeds(69.01%, 49/71)in patients with CKD which was significantly higher than that of non-CKD patients( 40.35% 69/171, χ2 = 5.3011, P<0.05).9、There were 49 patients with CKDin the CMBs group. There were 8 patients in CMBs stage1 group, which had 4,2,2 with CKDstage2 、 stage3 、 stage4 in it respectively.There were 15 patients in CMBs stage2 group, which had 5,6,4 with CKDstage2、stage3、stage4 in it respectively.There were 26 patients in CMBs stage3 group,which had 1,9,16 with CKDstage2、stage3、stage4 in it respectively.The Spearman correlation analysis showed that the severity of CMBs was positively correlated with the severity of CKD(r=0.843,P=0.0003).Conclusions:1、.CMBs mainly focused in deep gray matter area and infratentorial area.2、Venerable age(≥55),hypertension, proteinuria and CKD of patients with ischemic stroke were significantly correlated with cerebral microbleeds,which could be act as risk factors.3、The incidence of cerebral microbleeds in patients with CKD was significantly higher than of non-CKD patients.The severity of CMBs was positively correlated with the severity of CKD.4 、 CKD could be used as an independent predictor of ischemic stroke.The participation of proteinuria in diagnosis model could greatly improve the accuracy of prediction which indicate that proteinuria could be a useful predictor of ischemic stroke.