The Relationship Between Glomerular Filtration Rate And Cerebral Small Vessel Disease In Patients With Healthy Nervous System (No Cerebral Infarction Or Hemorrhage)

Objective:Some studies have shown that renal function is associated with Cerebral small vessel disease(CSVD),but it is mostly confined to patients with ischemic or hemorrhagic stroke or acute cerebral infarction,or the relationship between renal function and single Cerebral small vessel disease on imaging.The relationship between renal function and the total cerebrovascular lesion load(represented by the presence of multiple CSVD markers)is unclear in patients with healthy nervous system(no cerebral infarction or hemorrhage).and our study aimed to explore this relationship.Methods:A total of 286 patients with healthy neurological conditions(exclusive cerebral infarction,hemorrhage)underwent cranial magnetic resonance imaging(MRI)were selected and divided into CSVDO group(normal brain group),CSVD1 group and CSVD2-4 group according to their imaging findings and CSVD scores.A total of 102 patients with CKD were included in the study according to the diagnosis of CKD in 286 subjects,which were divided into CSVD0-1 group and CSVD2-4 group.All subjects were measured for serum creatinine(Scr)to estimate glomerular filtration rate(eGFR)to assess renal function.The medical history and biochemical examination data of the included subjects were collected in detail.Chi-square test and Mann-Whitney U test were used to compare the renal indexes and clinical data of subjects between groups,and Spearman correlation analysis was used to analyze the relationship between total imaging load score of cerebral small vessels and renal function and other indexes.The group was further divided according to the total load score of cerebral small vessel disease on imaging,and renal function and clinical data were compared between the groups by Kruskal-Wallis H test.ROC curve was used to evaluate the predictive value of renal function on the occurrence of cerebral small vessel disease,and Ordered and dichotomous Logistic regression were used to analyze the risk factors for the aggravation of total burden of cerebral small vessel disease.Results:1.In 286 patients with healthy nervous system(exclusive cerebral infarction,hemorrhage),correlation analysis showed that CSVD score was negatively correlated with eGFR and positively correlated with age and UA.According to the imaging score of cerebral small vascular lesions,there were statistically significant differences in the history of hypertension and diabetes among the three groups.There were statistically significant differences in age,eGFR and UA among different CSVD rating groups(P<0.05),among which eGFR:CSVDO group>CSVD1 group>CSVD2-4 group,and pair comparison between groups showed statistically significant differences.Compared with eGFR≥60,subjects with eGFR<60 had a higher risk of developing cerebral small vessel disease on imaging(OR 25.091,95%CI 3.399-185.195),and renal insufficiency(<60)had a 1.279-fold higher risk of developing small cerebrovascular lesions than those with good renal function(≥60).ROC curve was used to evaluate the efficacy of eGFR in predicting cerebral small vessel disease.The area under the eGFR curve was 0.715,which had certain predictive value.Orderly Logistic regression analysis of the aggravation of CSVD total load score showed that eGFR and age were still the risk factors for the aggravation of CSVD total burden after adjusting for the history of diabetes and hypertension and UA.2.Correlation analysis showed that CSVD score was negatively correlated with eGFR and positively correlated with BMI and UA in 102 patients with chronic kidney disease with healthy nervous system.There were significant differences in hypertension history,gender and diabetes history between the two groups with different CSVD scores(P<0.05).Compared with the group with low CSVD score,the group with high CSVD score had a lower eGFR and a higher BMI,and the differences were statistically significant.Binary Logistic regression analysis of CSVD burden aggravation showed that eGFR and BMI were still risk factors for CSVD on MRI after adjusting for history of hypertension,gender,UA and diabetes history.Conclusion:Renal insufficiency(low eGFR),increased age,and increased BMI are associated with the total load of CSVD on imaging and are risk factors for cerebral small vessel disease.eGFR,age and BMI have certain clinical value in predicting the occurrence of cerebral small vessel disease on imaging,and have certain clinical guiding value in predicting the development and prognosis of diseases in early renal insufficiency.