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dc.contributor.authorCastro, Pedro
dc.contributor.authorAzevedo, Elsa
dc.contributor.authorRocha, Isabel
dc.contributor.authorSorond, Farzaneh
dc.contributor.authorSerrador, Jorge M.
dc.date.accessioned2018-09-20T16:02:53Z
dc.date.available2018-09-20T16:02:53Z
dc.date.issued2018-03-02
dc.identifier.citationCastro, Pedro; Azevedo, Elsa; Rocha, Isabel; Sorond, Farzaneh; Serrador, Jorge M. (2018). Chronic kidney disease and poor outcomes in ischemic stroke: is impaired cerebral autoregulation the missing link?. BMC Neurology 18 ,
dc.identifier.issn1471-2377
dc.identifier.urihttp://hdl.handle.net/10379/10721
dc.description.abstractBackground: 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.
dc.publisherSpringer Nature
dc.relation.ispartofBMC Neurology
dc.subjectcardiovascular disease
dc.subjectchronic kidney disease
dc.subjectglomerular filtration rate
dc.subjectstroke
dc.subjecttranscranial doppler
dc.subjectglomerular-filtration-rate
dc.subjectspontaneously hypertensive-rats
dc.subjectwhite-matter lesions
dc.subjectblood-flow
dc.subjecthemorrhagic transformation
dc.subjectcerebrovascular hemodynamics
dc.subjectintracerebral hemorrhage
dc.subjectmyogenic mechanisms
dc.subjectrenal damage
dc.subjectrisk-factor
dc.titleChronic kidney disease and poor outcomes in ischemic stroke: is impaired cerebral autoregulation the missing link?
dc.typeArticle
dc.identifier.doi10.1186/s12883-018-1025-4
dc.local.publishedsourcehttps://bmcneurol.biomedcentral.com/track/pdf/10.1186/s12883-018-1025-4
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