Correlation of Silent Brain Infarction with the Metabolic Abnormality of CKD Stage 3-5 (non-dialytic) Patients

Abstract

Background: Silent brain infarction (SBI) poses a significant yet often undetected risk in chronic kidney disease (CKD) patients, predisposing them to symptomatic stroke, dementia, and neurological mortality. Despite its implications, the association between SBI and CKD remains elusive, necessitating further exploration to elucidate potential predictive factors. Objective: This cross-sectional study investigated the relationship between SBI and metabolic abnormalities prevalent in CKD stages 3-5 (non-dialytic) patients. Methods: Conducted at the Department of Nephrology, Dhaka Medical College Hospital, Dhaka, from September 2018 to March 2020, the study enrolled 115 participants. Group I comprised 85 CKD stage 3-5 (non-dialytic) patients without neurological symptoms, while Group II comprised 30 healthy controls. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Diseases equation. Magnetic resonance imaging (MRI) was performed on all subjects. Statistical analysis utilized SPSS-26. Results: The rate of Silent Brain Infarction is 52.9% in CKD patients. SBI was found in 45(52.9%) patients in group I and 4(13.3%) in group II. The differences were statistically significant (p<0.05). Glomerulonephritis (45.9%) was the leading cause of CKD among the study patients. Most of the patients with Hypertensive Nephrosclerosis (76.9%) had SBI, which indirectly showed its strong association. As the CKD stages progressed, the SBI rate also increased (stage-3:8.9%; stage-4:35.6%; stage-5ND:55.6%). In a multivariate logistic regression analysis, CKD had an independent relationship with SBI along with serum phosphate level and serum parathyroid hormone level (CKD had Odds ratio (OR)=1.847 (95.0% CI 0.064 to 53.319), serum PO4 had OR=0.958 (95.0% CI 0.885 to 1.038) and serum PTH had OR=0.996 (95.0% CI 0.993 to 1.000). Spearman rank correlation coefficient test showed a positive correlation between the occurrence of SBI and serum PO4 level (r=0.416; p=0.001) and serum PTH level (r= 0.405; p=0.001) separately. Conclusions: The high prevalence of SBI in CKD stage 3-5 (non-dialytic) patients underscores its clinical significance. Serum phosphate and parathyroid hormone levels positively correlate with SBI occurrence, highlighting their potential as predictive markers. Understanding these associations can inform risk stratification and guide targeted interventions in CKD management.