Associations of renal function with cerebral small vessel disease and functional outcome in acute intracerebral haemorrhage: A hospital-based prospective cohort study
Intracerebral haemorrhage (ICH) is a severe clinical consequence of cerebral small vessel disease (SVD), but associations between renal impairment and SVD in patients with ICH have not been fully characterised. Using data from the CROMIS-2 ICH observational study, we compared SVD neuroimaging marker...
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| Veröffentlicht in: | Journal of the neurological sciences 2023-09, Vol.452, p.120743, Article 120743 |
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| creator | Nash, Philip S. Best, Jonathan G. Ambler, Gareth Wilson, Duncan Banerjee, Gargi Hostettler, Isabel C. Seiffge, David Cohen, Hannah Yousry, Tarek A. Salman, Rustam Al-Shahi Lip, Gregory Y.H. Brown, Martin M. Muir, Keith W. Houlden, Henry Jäger, Hans Rolf Werring, David J. |
| description | Intracerebral haemorrhage (ICH) is a severe clinical consequence of cerebral small vessel disease (SVD), but associations between renal impairment and SVD in patients with ICH have not been fully characterised.
Using data from the CROMIS-2 ICH observational study, we compared SVD neuroimaging markers and total burden (score 0–3) identified using CT brain imaging in patients with and without renal impairment (estimated glomerular filtration rate, eGFR |
| doi_str_mv | 10.1016/j.jns.2023.120743 |
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Using data from the CROMIS-2 ICH observational study, we compared SVD neuroimaging markers and total burden (score 0–3) identified using CT brain imaging in patients with and without renal impairment (estimated glomerular filtration rate, eGFR<60). We assessed functional outcome at 6-month follow-up using the modified Rankin scale.
1027 participants were included (mean age 72.8, 57.1% male); 274 with and 753 without renal impairment. 18.7% of the eGFR<60 group had moderate-to-severe SVD burden (score 2–3), compared with 14.0% of those with eGFR>60 (p = 0.039). SVD burden was associated with renal impairment after adjusting for hypertension (OR 1.36, 95% CI 1.04–1.77, p = 0.023), but not after adjusting for age. Cerebral atrophy was more prevalent in patients with eGFR<60 (81.2% vs. 72.0%, p = 0.002), as were WMH (45.6% vs. 36.6%, p = 0.026). Neither was associated with renal function after adjusting for age and vascular risk factors. Renal impairment was associated with functional outcome (OR 0.65, 95% CI 0.47–0.89, p = 0.007), but not after adjusting for age, pre-morbid function and comorbidities (OR 0.95, 95% CI 0.65–1.38, p = 0.774).
In acute ICH, renal impairment is associated with a higher cerebral SVD burden independent of hypertension, but not age. Reduced eGFR is associated with worse functional outcome, but not independent of age and comorbidities. Since CT has limited sensitivity to detect SVD severity and distribution, further studies including MRI are needed.
•Intracerebral haemorrhage patients with renal impairment have a severe burden of cerebral small vessel disease (SVD).•In this study renal impairment is associated with CT-assessed SVD burden independent of hypertension.•Renal impairment is not associated with SVD burden after adjustment for age, sex and comorbidities.•Further studies using brain MRI are needed to better assess the relationships between renal function and SVD.</description><identifier>ISSN: 0022-510X</identifier><identifier>ISSN: 1878-5883</identifier><identifier>EISSN: 1878-5883</identifier><identifier>DOI: 10.1016/j.jns.2023.120743</identifier><identifier>PMID: 37531792</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Cerebral Hemorrhage - complications ; Cerebral Hemorrhage - diagnostic imaging ; Cerebral Hemorrhage - epidemiology ; Cerebral small vessel disease (SVD) ; Cerebral Small Vessel Diseases - complications ; Cerebral Small Vessel Diseases - diagnostic imaging ; Chronic kidney disease (CKD) ; Female ; Humans ; Hypertension - complications ; Intracerebral haemorrhage (ICH) ; Kidney - diagnostic imaging ; Kidney - physiology ; Magnetic Resonance Imaging ; Male ; Outcome after stroke ; Prospective Studies</subject><ispartof>Journal of the neurological sciences, 2023-09, Vol.452, p.120743, Article 120743</ispartof><rights>2023</rights><rights>Copyright © 2023. Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-1af6b4e1643769d6ca7f489464c4e210d952477614b66b8e565607d5286006853</citedby><cites>FETCH-LOGICAL-c396t-1af6b4e1643769d6ca7f489464c4e210d952477614b66b8e565607d5286006853</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jns.2023.120743$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37531792$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nash, Philip S.</creatorcontrib><creatorcontrib>Best, Jonathan G.</creatorcontrib><creatorcontrib>Ambler, Gareth</creatorcontrib><creatorcontrib>Wilson, Duncan</creatorcontrib><creatorcontrib>Banerjee, Gargi</creatorcontrib><creatorcontrib>Hostettler, Isabel C.</creatorcontrib><creatorcontrib>Seiffge, David</creatorcontrib><creatorcontrib>Cohen, Hannah</creatorcontrib><creatorcontrib>Yousry, Tarek A.</creatorcontrib><creatorcontrib>Salman, Rustam Al-Shahi</creatorcontrib><creatorcontrib>Lip, Gregory Y.H.</creatorcontrib><creatorcontrib>Brown, Martin M.</creatorcontrib><creatorcontrib>Muir, Keith W.</creatorcontrib><creatorcontrib>Houlden, Henry</creatorcontrib><creatorcontrib>Jäger, Hans Rolf</creatorcontrib><creatorcontrib>Werring, David J.</creatorcontrib><creatorcontrib>CROMIS-2 collaborators</creatorcontrib><title>Associations of renal function with cerebral small vessel disease and functional outcome in acute intracerebral haemorrhage: A hospital-based prospective cohort study</title><title>Journal of the neurological sciences</title><addtitle>J Neurol Sci</addtitle><description>Intracerebral haemorrhage (ICH) is a severe clinical consequence of cerebral small vessel disease (SVD), but associations between renal impairment and SVD in patients with ICH have not been fully characterised.
Using data from the CROMIS-2 ICH observational study, we compared SVD neuroimaging markers and total burden (score 0–3) identified using CT brain imaging in patients with and without renal impairment (estimated glomerular filtration rate, eGFR<60). We assessed functional outcome at 6-month follow-up using the modified Rankin scale.
1027 participants were included (mean age 72.8, 57.1% male); 274 with and 753 without renal impairment. 18.7% of the eGFR<60 group had moderate-to-severe SVD burden (score 2–3), compared with 14.0% of those with eGFR>60 (p = 0.039). SVD burden was associated with renal impairment after adjusting for hypertension (OR 1.36, 95% CI 1.04–1.77, p = 0.023), but not after adjusting for age. Cerebral atrophy was more prevalent in patients with eGFR<60 (81.2% vs. 72.0%, p = 0.002), as were WMH (45.6% vs. 36.6%, p = 0.026). Neither was associated with renal function after adjusting for age and vascular risk factors. Renal impairment was associated with functional outcome (OR 0.65, 95% CI 0.47–0.89, p = 0.007), but not after adjusting for age, pre-morbid function and comorbidities (OR 0.95, 95% CI 0.65–1.38, p = 0.774).
In acute ICH, renal impairment is associated with a higher cerebral SVD burden independent of hypertension, but not age. Reduced eGFR is associated with worse functional outcome, but not independent of age and comorbidities. Since CT has limited sensitivity to detect SVD severity and distribution, further studies including MRI are needed.
•Intracerebral haemorrhage patients with renal impairment have a severe burden of cerebral small vessel disease (SVD).•In this study renal impairment is associated with CT-assessed SVD burden independent of hypertension.•Renal impairment is not associated with SVD burden after adjustment for age, sex and comorbidities.•Further studies using brain MRI are needed to better assess the relationships between renal function and SVD.</description><subject>Cerebral Hemorrhage - complications</subject><subject>Cerebral Hemorrhage - diagnostic imaging</subject><subject>Cerebral Hemorrhage - epidemiology</subject><subject>Cerebral small vessel disease (SVD)</subject><subject>Cerebral Small Vessel Diseases - complications</subject><subject>Cerebral Small Vessel Diseases - diagnostic imaging</subject><subject>Chronic kidney disease (CKD)</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension - complications</subject><subject>Intracerebral haemorrhage (ICH)</subject><subject>Kidney - diagnostic imaging</subject><subject>Kidney - physiology</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Outcome after stroke</subject><subject>Prospective Studies</subject><issn>0022-510X</issn><issn>1878-5883</issn><issn>1878-5883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu3CAQhlHVqtmkfYBeKo69eAsYA25PqyhtKkXqJZF6QxjGNSvbbAFvlBfKcxZr0z32BIy--TTMj9AHSraUUPF5v93PacsIq7eUEcnrV2hDlVRVo1T9Gm0IYaxqKPl1gS5T2hNChFLtW3RRy6amsmUb9LxLKVhvsg9zwqHHEWYz4n6Z7VrCjz4P2EKELpZymsw44iOkBCN2PoFJgM3sznxhwpJtmAD7GRu75PWSozkrBgNTiHEwv-EL3uEhpIPPZqy6onL4EMsbiuoI2IYhxIxTXtzTO_SmN2OC9y_nFXr4dnN_fVvd_fz-43p3V9m6FbmiphcdByp4LUXrhDWy56rlglsOjBLXNoxLKSjvhOgUNKIRRLqGKbHupqmv0KeTtwzyZ4GU9eSThXE0M4QlaaZ46ZGCi4LSE2rLzClCrw_RTyY-aUr0Go_e6xKPXuPRp3hKz8cX_dJN4M4d__IowNcTAOWTRw9RJ-thtuB8LGvRLvj_6P8C9D2jQg</recordid><startdate>20230915</startdate><enddate>20230915</enddate><creator>Nash, Philip S.</creator><creator>Best, Jonathan G.</creator><creator>Ambler, Gareth</creator><creator>Wilson, Duncan</creator><creator>Banerjee, Gargi</creator><creator>Hostettler, Isabel C.</creator><creator>Seiffge, David</creator><creator>Cohen, Hannah</creator><creator>Yousry, Tarek A.</creator><creator>Salman, Rustam Al-Shahi</creator><creator>Lip, Gregory Y.H.</creator><creator>Brown, Martin M.</creator><creator>Muir, Keith W.</creator><creator>Houlden, Henry</creator><creator>Jäger, Hans Rolf</creator><creator>Werring, David J.</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20230915</creationdate><title>Associations of renal function with cerebral small vessel disease and functional outcome in acute intracerebral haemorrhage: A hospital-based prospective cohort study</title><author>Nash, Philip S. ; Best, Jonathan G. ; Ambler, Gareth ; Wilson, Duncan ; Banerjee, Gargi ; Hostettler, Isabel C. ; Seiffge, David ; Cohen, Hannah ; Yousry, Tarek A. ; Salman, Rustam Al-Shahi ; Lip, Gregory Y.H. ; Brown, Martin M. ; Muir, Keith W. ; Houlden, Henry ; Jäger, Hans Rolf ; Werring, David J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-1af6b4e1643769d6ca7f489464c4e210d952477614b66b8e565607d5286006853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Cerebral Hemorrhage - complications</topic><topic>Cerebral Hemorrhage - diagnostic imaging</topic><topic>Cerebral Hemorrhage - epidemiology</topic><topic>Cerebral small vessel disease (SVD)</topic><topic>Cerebral Small Vessel Diseases - complications</topic><topic>Cerebral Small Vessel Diseases - diagnostic imaging</topic><topic>Chronic kidney disease (CKD)</topic><topic>Female</topic><topic>Humans</topic><topic>Hypertension - complications</topic><topic>Intracerebral haemorrhage (ICH)</topic><topic>Kidney - diagnostic imaging</topic><topic>Kidney - physiology</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Outcome after stroke</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nash, Philip S.</creatorcontrib><creatorcontrib>Best, Jonathan G.</creatorcontrib><creatorcontrib>Ambler, Gareth</creatorcontrib><creatorcontrib>Wilson, Duncan</creatorcontrib><creatorcontrib>Banerjee, Gargi</creatorcontrib><creatorcontrib>Hostettler, Isabel C.</creatorcontrib><creatorcontrib>Seiffge, David</creatorcontrib><creatorcontrib>Cohen, Hannah</creatorcontrib><creatorcontrib>Yousry, Tarek A.</creatorcontrib><creatorcontrib>Salman, Rustam Al-Shahi</creatorcontrib><creatorcontrib>Lip, Gregory Y.H.</creatorcontrib><creatorcontrib>Brown, Martin M.</creatorcontrib><creatorcontrib>Muir, Keith W.</creatorcontrib><creatorcontrib>Houlden, Henry</creatorcontrib><creatorcontrib>Jäger, Hans Rolf</creatorcontrib><creatorcontrib>Werring, David J.</creatorcontrib><creatorcontrib>CROMIS-2 collaborators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the neurological sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nash, Philip S.</au><au>Best, Jonathan G.</au><au>Ambler, Gareth</au><au>Wilson, Duncan</au><au>Banerjee, Gargi</au><au>Hostettler, Isabel C.</au><au>Seiffge, David</au><au>Cohen, Hannah</au><au>Yousry, Tarek A.</au><au>Salman, Rustam Al-Shahi</au><au>Lip, Gregory Y.H.</au><au>Brown, Martin M.</au><au>Muir, Keith W.</au><au>Houlden, Henry</au><au>Jäger, Hans Rolf</au><au>Werring, David J.</au><aucorp>CROMIS-2 collaborators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Associations of renal function with cerebral small vessel disease and functional outcome in acute intracerebral haemorrhage: A hospital-based prospective cohort study</atitle><jtitle>Journal of the neurological sciences</jtitle><addtitle>J Neurol Sci</addtitle><date>2023-09-15</date><risdate>2023</risdate><volume>452</volume><spage>120743</spage><pages>120743-</pages><artnum>120743</artnum><issn>0022-510X</issn><issn>1878-5883</issn><eissn>1878-5883</eissn><abstract>Intracerebral haemorrhage (ICH) is a severe clinical consequence of cerebral small vessel disease (SVD), but associations between renal impairment and SVD in patients with ICH have not been fully characterised.
Using data from the CROMIS-2 ICH observational study, we compared SVD neuroimaging markers and total burden (score 0–3) identified using CT brain imaging in patients with and without renal impairment (estimated glomerular filtration rate, eGFR<60). We assessed functional outcome at 6-month follow-up using the modified Rankin scale.
1027 participants were included (mean age 72.8, 57.1% male); 274 with and 753 without renal impairment. 18.7% of the eGFR<60 group had moderate-to-severe SVD burden (score 2–3), compared with 14.0% of those with eGFR>60 (p = 0.039). SVD burden was associated with renal impairment after adjusting for hypertension (OR 1.36, 95% CI 1.04–1.77, p = 0.023), but not after adjusting for age. Cerebral atrophy was more prevalent in patients with eGFR<60 (81.2% vs. 72.0%, p = 0.002), as were WMH (45.6% vs. 36.6%, p = 0.026). Neither was associated with renal function after adjusting for age and vascular risk factors. Renal impairment was associated with functional outcome (OR 0.65, 95% CI 0.47–0.89, p = 0.007), but not after adjusting for age, pre-morbid function and comorbidities (OR 0.95, 95% CI 0.65–1.38, p = 0.774).
In acute ICH, renal impairment is associated with a higher cerebral SVD burden independent of hypertension, but not age. Reduced eGFR is associated with worse functional outcome, but not independent of age and comorbidities. Since CT has limited sensitivity to detect SVD severity and distribution, further studies including MRI are needed.
•Intracerebral haemorrhage patients with renal impairment have a severe burden of cerebral small vessel disease (SVD).•In this study renal impairment is associated with CT-assessed SVD burden independent of hypertension.•Renal impairment is not associated with SVD burden after adjustment for age, sex and comorbidities.•Further studies using brain MRI are needed to better assess the relationships between renal function and SVD.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>37531792</pmid><doi>10.1016/j.jns.2023.120743</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Cerebral Hemorrhage - complications Cerebral Hemorrhage - diagnostic imaging Cerebral Hemorrhage - epidemiology Cerebral small vessel disease (SVD) Cerebral Small Vessel Diseases - complications Cerebral Small Vessel Diseases - diagnostic imaging Chronic kidney disease (CKD) Female Humans Hypertension - complications Intracerebral haemorrhage (ICH) Kidney - diagnostic imaging Kidney - physiology Magnetic Resonance Imaging Male Outcome after stroke Prospective Studies |
| title | Associations of renal function with cerebral small vessel disease and functional outcome in acute intracerebral haemorrhage: A hospital-based prospective cohort study |
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