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Published ahead of print on January 28, 2010
J Am Soc Nephrol 21: 520-526, 2010
© 2010 American Society of Nephrology
doi: 10.1681/ASN.2009050558
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CLINICAL RESEARCH

Cerebral Microvascular Disease Predicts Renal Failure in Type 2 Diabetes

Takashi Uzu*, Yasuo Kida{dagger}, Nobuo Shirahashi{ddagger}, Tamaki Harada§, Atsushi Yamauchi||, Makoto Nomura||, Keiji Isshiki*, Shin-ichi Araki*, Toshiro Sugimoto*, Daisuke Koya, Masakazu Haneda**, Atsunori Kashiwagi* and Ryuichi Kikkawa*

*Shiga University of Medical Science, Otsu, Shiga, Japan;
{dagger}The Second Okamoto Hospital, Uji, Kyoto, Japan;
{ddagger}Osaka City University, Osaka, Japan;
§Higashi-Osaka City Hospital, Higashi-Osaka, Japan;
||Osaka Rosai Hospital, Sakai, Osaka, Japan;
Kanazawa Medical University, Kahoku-Gun, Ishikawa, Japan; and
**Asahikawa Medical College, Asahikawa, Hokkaido, Japan

Correspondence: Dr. Takashi Uzu, Department of Medicine, Shiga University of Medical Science, Seta, Otsu 520-2192, Japan. Phone +81-77-548-2222; Fax: +81-77-543-3858; E-mail: takuzu{at}belle.shiga-med.ac.jp

Received for publication November 19, 2009. Abnormalities in small renal vessels may increase the risk of developing impaired renal function, but methods to assess these vessels are extremely limited. We hypothesized that the presence of small vessel disease in the brain, which manifests as silent cerebral infarction (SCI), may predict the progression of kidney disease in patients with type 2 diabetes. We recruited 608 patients with type 2 diabetes without apparent cerebrovascular or cardiovascular disease or overt nephropathy and followed them for a mean of 7.5 years. At baseline, 177 of 608 patients had SCI, diagnosed by cerebral magnetic resonance imaging. The risk for the primary outcome of ESRD or death was significantly higher for patients with SCI than for patients without SCI [hazard ratio, 2.44; 95% confidence interval (CI) 1.36 to 4.38]. The risk for the secondary renal end point of any dialysis or doubling of the serum creatinine concentration was also significantly higher for patients with SCI (hazard ratio, 4.79; 95% CI 2.72 to 8.46). The estimated GFR declined more in patients with SCI than in those without SCI; however, the presence of SCI did not increase the risk for progression of albuminuria. In conclusion, independent of microalbuminuria, cerebral microvascular disease predicted renal morbidity among patients with type 2 diabetes.


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J. Am. Soc. Nephrol. 2010 21: A15. [Full Text] [PDF]





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