Kidney Week

Abstract: FR-PO1159

Kidney Impairment Exacerbates Periventricular White Matter Hyperintensities in Patients with CKD

Session Information

• CKD: Kidney Function and Extrarenal Complications
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Shen, Feng-Ching, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Feng-Ching Shen, MD

• Lin, Yi-Ting, Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Yi-Ting Lin, MD, PhD

• Lin, Ming-Yen, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Ming-Yen Lin, PhD

• Kuo, Mei-Chuan, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Mei-Chuan Kuo, MD

• Chiu, Yi-Wen, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Yi-Wen Chiu, MD

• Chang, Jer-Ming, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Jer-Ming Chang, MD, PhD

• Hwang, Shang-Jyh, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Shang-Jyh Hwang, MD

• Wu, Ping-Hsun, Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Ping-Hsun Wu, MD, MS

Background

Cognitive impairment is commonly observed in patients with chronic kidney disease (CKD) and tends to worsen as estimated glomerular filtration rate (eGFR) declines and albuminuria increases. Brain magnetic resonance imaging (MRI) scans are valuable in detecting structural brain lesions. Cerebral white matter hyperintensities (WMHs), indicating small vessel diseases, are associated with cognitive decline. The Fazekas scale quantifies WMHs and highlights parenchymal changes in brain MRI. This study investigated the association between kidney function status (eGFR and albuminuria) and WMHs in CKD.

Methods

A cross-sectional study of 1,738 CKD patients was conducted at Kaohsiung Medical University Hospital, Taiwan. Brain MRI scans were utilized to measure WMHs according to the Fazekas scale, separately assessing periventricular WMHs (PWMHs) and deep WMHs (DWMHs). The eGFR was calculated using the MDRD formula. The urinary albumin to creatinine ratio (UACR) was categorized into three stages with cutoff values at 30 mg/g and 300 mg/g. The prognosis of CKD was accessed based on the 2024 KDIGO guidelines, considering both eGFR and albuminuria. Ordinal regression models with potential confounders adjustment were used for the analysis.

Results

Impaired renal functions are associated with increased severity of PWMHs. An increase in eGFR is linked to a decrease in PWMHs with an odds ratio (OR) of 0.987 (95% confidence interval [CI]: 0.979-0.994, p < 0.001). UACR stage 3 shows a significant association with increased PWMHs (OR [95% CI]: 1.645 [1.066-2.540], p = 0.024) compared with UACR stage 1. Those catagorized as very high-risk group by KDIGO guidelines are associated with increased PWMHs (OR [95% CI]: 1.832 [1.184-2.840], p = 0.007), compared to those with low and moderately increased risk. However, impaired renal functions are not associated with DWMHs.

Conclusion

Our findings highlight the impact of renal impairment on brain damage in CKD patients, as evidenced by the increased severity of PWMHs. DWMH shows no significant association with renal function.

Association between Fazekas Scale with CKD stage and UACR stage