血管周围空间增大和小血管疾病总负担与肾功能的关系
Association of Enlarged Perivascular Spaces and Total Small Vessel Disease Burden With Kidney Function.
Philip S Nash, Gareth Ambler, Jonathan G Best, Duncan Wilson, Houwei Du, Rustam Al-Shahi Salman, Hans Rolf Jäger, Gregory Y H Lip, Martina B Goeldlin, Morin Beyeler, Philipp Bücke, Marwan El-Koussy, Heinrich P Mattle, Leonidas Panos, Dianne H K van Dam-Nolen, Florian Dubost, Jeroen Hendrikse, M Eline Kooi, Werner H Mess, Paul J Nederkoorn, Nicolas Christ, Maximilian Bellut, Sarah Gunkel, Christopher Charles Karayiannis, John Ly, Shaloo Singhal, Lee-Anne Slater, Young Dae Kim, Keon-Joo Lee, Jae-Sung Lim, Hideo Hara, Masashi Nishihara, Jun Tanaka, Masaaki Yoshikawa, Derya Selcuk Demirelli, Zeynep Tanriverdi, Ender Uysal, Shelagh B Coutts, Francesca M Chappell, Stephen Dj Makin, Henry Ka Fung Mak, Kay Cheong Teo, Debbie Y K Wong, Lisa Hert, Marta Kubacka, Philippe A Lyrer, Alexandros A Polymeris, Benjamin Wagner, Annaelle Zietz, Jill Abrigo, Cyrus Cheng, Winnie Cw Chu, Thomas W Leung, David Julian Seiffge, Urs Fischer, Simon Jung, Daniel Bos, Felix Fluri, Thanh G Phan, Velandai K Srikanth, Ji Hoe Heo, Hee-Joon Bae, Yusuke Yakushiji, Dilek Necioglu Orken, Eric E Smith, Joanna M Wardlaw, Gary Kui Kai Lau, Stefan T Engelter, Nils Peters, Yannie O Y Soo, Tae-Jin Song, Robert J Simister, David C Wheeler, David J Werring
Neurology(神经病学)
2026-08-25
IF: 8.500
Q1
PMID: 42551001
DOI: 10.1212/WNL.0000000000218406
Abstract
Enlarged perivascular spaces (EPVSs) in the basal ganglia (BG-EPVS) are an important marker of cerebral small vessel disease (cSVD), and EPVS in the centrum semiovale (CSO-EPVS) are part of the diagnostic criteria for cerebral amyloid angiopathy. We aimed to investigate associations of EPVS with reduced estimated glomerular filtration rate (eGFR) and glomerular hyperfiltration (higher than normal eGFR), which have scarcely been studied previously. In this cross-sectional study, we used pooled individual patient data from the Microbleeds International Collaborative Network which includes patients with ischemic stroke or transient ischemic attack. We investigated associations of impaired kidney function, defined as an eGFR of 30-60 or <30 mL/minute/1.73 m, and glomerular hyperfiltration, defined as eGFR above the age-adjusted and sex-adjusted 95th centile, with BG-EPVS and CSO-EPVS severity. EPVS were rated according to a validated 5-point ordinal scale, and combined cSVD burden was rated using a validated 5-point ordinal scale with 1 point assigned for the presence of each of the following: severe white matter hyperintensities, ≥1 cerebral microbleed, ≥1 lacune, and BG-EPVS ≥11. Normal glomerular filtration was defined as eGFR ≥60 without hyperfiltration. We used multivariable ordinal logistic regression models to estimate risk of increased EPVS and cSVD burden severity adjusted for age, sex, and comorbidities. Seven thousand two hundred fifty-four patients (mean age 71 ± 13 years, 43% female) were included in the analysis, 357 with glomerular hyperfiltration, 1,692 with eGFR 30-60, and 256 with eGFR <30. Compared with normal glomerular filtration, hyperfiltration was independently associated with BG-EPVS (adjusted odds ratio [aOR] 1.38, 95% CI 1.11-1.70, < 0.001) and CSO-EPVS (aOR 1.34, 95% CI 1.08-1.64, = 0.011). Associations of eGFR 30-60 and eGFR <30 with EPVS were not statistically significant. Compared with normal glomerular filtration, eGFR <30 (aOR 1.27, 95% CI 1.03-1.57) was independently associated with increased cSVD burden, but eGFR 30-60 (aOR 1.06, 95% CI 0.95-1.20) and hyperfiltration (aOR 1.15, 95% CI 0.98-1.34) were not. Glomerular hyperfiltration was independently associated with EPVS severity, in both the basal ganglia and centrum semiovale. eGFR <30 was independently associated with total cSVD burden. A key limitation was a lack of repeated eGFR measurements.