CKD and cerebral microbleeds
Claude Nguyen, MD
Association of Chronic Kidney Disease With Cerebral Microbleeds in Patients With Primary Intracerebral Hemorrhage. Stroke. 2013
Chronic kidney disease (CKD) has been traditionally linked to a higher risk of ischemic stroke, though biologically, one would expect intracerebral hemorrhage (ICH) to be more plausible. To further explore the relationship between CKD and ICH, Ovbiagele et al. performed a retrospective review of data from the ongoing DECIPHER trial, a longitudinal trial looking at differences in race and ICH in the Washington, DC area. Three investigators reviewed imaging, focusing on the admission MRI; GRE sequences were assessed for hematoma volume, location, and number of microbleeds, presence of chronic bleeds, and IVH. Using a multivariate model that adjusted for age, sex, average BP, and history of hypertension or white matter disease, these bleeding characteristics were compared to renal function (eGFR) and use of medications affecting the kidneys (mainly ACE inhibitors).
Through its 197 patients, the group found an association between baseline CKD and both the presence and number of cerebral microbleeds, even after adjusting for admission BP. The authors point out that this was a cross-sectional cohort, and that the inclusion criteria excluded more severe ICH’s. Nevertheless, this study may add weight to the biologically plausible theory that CKD leads to microangiopathy, which increases risk for ICH. Although the study, by design, could not produce risk ratios for those with CKD enduring ICH later on in life, the study further implicates CKD in ICH, emphasizes the importance of treating those with CKD, and using CKD as a potential therapeutic targets.
The study found the association between CKD and microbleeds to be true in black patients but not in non-Hispanic whites. The implications of race and its role in CKD and microbleeds, however, should be taken with caution. Although this further emphasizes the importance of treating HTN and CKD in blacks, the lack of this association in other groups may cause CKD to be taken less seriously in other groups. The group does cite the DECIPHER study’s predominantly African American population and lack of statistical power in other ethnic groups for lack of this association. This study should speak solely to the notion that the cause and prevalence of CKD may be different between groups. Clinicians should be as aggressive at the diagnosis and treatment of such chronic conditions as CKD regardless of background.