Chronic kidney disease and poor outcomes in ischemic stroke: is impaired cerebral autoregulation the missing link?

• Type: Article in International Scientific Journal
• Date: 2018

Authors

Pedro Castro (Author) FMUP; Elsa Azevedo (Author) FMUP; Rocha, I (Author) Other; Sorond, F (Author) Other; Serrador, JM (Author) Other

Journal

Title: BMC Neurology

Vol. 18

ISSN: 1471-2377

Publisher: Springer Nature

Indexing

ISI Web of Knowledge - 31 Citations

Scopus - 31 Citations

Other information

Authenticus ID: P-00N-QD8

DOI: 10.1186/s12883-018-1025-4

Abstract (EN): Background: Chronic kidney disease increases stroke incidence and severity but the mechanisms behind this cerebrorenal interaction are mostly unexplored. Since both vascular beds share similar features, microvascular dysfunction could be the possible missing link. Therefore, we examined the relationship between renal function and cerebral autoregulation in the early hours post ischemia and its impact on outcome. Methods: We enrolled 46 ischemic strokes (middle cerebral artery). Dynamic cerebral autoregulation was assessed by transfer function (coherence, phase and gain) of spontaneous blood pressure oscillations to blood flow velocity within 6 h from symptom-onset. Estimated glomerular filtration rate (eGFR) was calculated. Hemorrhagic transformation (HT) and white matter lesions (WML) were collected from computed tomography performed at presentation and 24 h. Outcome was evaluated with modified Rankin Scale at 3 months. Results: High gain (less effective autoregulation) was correlated with lower eGFR irrespective of infarct side (p < 0.05). Both lower eGFR and higher gain correlated with WML grade (p < 0.05). Lower eGFR and increased gain, alone and in combination, progressively reduced the odds of a good functional outcome [ipsilateral OR = 4.39 (CI95% 3.15-25.6), p = 0. 019; contralateral OR = 8.15 (CI95% 4.15-15.6), p = 0.002] and increased risk of HT [ipsilateral OR = 3.48 (CI95% 0.60-24.0), p = 0.132; contralateral OR = 6.43 (CI95% 1.40-32.1), p = 0.034]. Conclusions: Lower renal function correlates with less effective dynamic cerebral autoregulation in acute ischemic stroke, both predicting a bad outcome. The evaluation of serum biomarkers of renal dysfunction could have interest in the future for assessing cerebral microvascular risk and relationship with stroke complications.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 11