Association of Enlarged Perivascular Spaces and Total Small Vessel Disease Burden With Kidney Function.

Background And Objectives 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.Methods 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 m2, 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.Results 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, p < 0.001) and CSO-EPVS (aOR 1.34, 95% CI 1.08-1.64, p = 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.Discussion 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.

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Open Access CRIS of the University of Bern
Published
2026-08-25
DOI
https://doi.org/10.48620/100105
Primary Topic
Cerebrospinal fluid and hydrocephalus
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article
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article

Association of Enlarged Perivascular Spaces and Total Small Vessel Disease Burden With Kidney Function.

Maximilian Bellut, Florian Dubost, Joanna Marguerite Wardlaw, Martina Goeldlin et al.
Open Access CRIS of the University of Bern
Cerebrospinal fluid and hydrocephalus
article

Association of Enlarged Perivascular Spaces and Total Small Vessel Disease Burden With Kidney Function.

Maximilian Bellut, Florian Dubost, Joanna Marguerite Wardlaw, Martina Goeldlin, Young Dae Kim, Benjamin Wagner, Shelagh B. Coutts, Werner H. Mess, Hideo Hara, Jae‐Sung Lim, Shaloo Singhal, Philippe Lyrer, Thanh G. Phan, Sarah Gunkel, Houwei Du, Lisa Hert, Francesca M. Chappell, Duncan Wilson, Lee‐Anne Slater, Dilek Neci̇oğlu Örken, Christopher Karayiannis, Jonathan G. Best, Annaelle Zietz, David Julian Seiffge, Velandai Srikanth, Jeroen Hendrikse, Cyrus Cheng, Masashi Nishihara, Robert Simister, Nicolas Christ, Derya Selçuk Demirelli, Ender Uysal, Gregory Lip, Marta Kubacka, Daniel Bos, Philipp Bücke, Leonidas Panos, Winnie CW Chu, Ji Hoe Heo, Zeynep Tanrıverdi, John Van Ly, Marwan El-Koussy, Dianne H K van Dam-Nolen, Debbie Y K Wong, Jill Abrigo, Philip S Nash, David C Wheeler, Masaaki Yoshikawa, Jun Tanaka, Kay Cheong Teo, Felix Fluri, David J Werring, Nils Peters, Stefan T Engelter, Heinrich P. Mattle, M Eline Kooi, Paul J Nederkoorn, Hans Rolf Jäger, Yannie O Y Soo, Stephen Dj Makin, Simon Jung, Thomas W Leung, Keon-Joo Lee, Yusuke Yakushiji, Henry Ka Fung Mak, Gareth Ambler, Morin Beyeler, Urs Fischer, Gary Kui Kai Lau, Hee-Joon Bae, Alexandros A Polymeris, Rustam Al-Shahi Salman, Tae-Jin Song, Eric E Smith
article en

Abstract

Background And Objectives 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.Methods 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 m2, 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.Results 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, p < 0.001) and CSO-EPVS (aOR 1.34, 95% CI 1.08-1.64, p = 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.Discussion 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.

Open Access CRIS of the University of Bern
University Clinic of Traumatology (AT)
Partnerships for the goals
Openalex Percentile: Top 20%
Cerebrospinal fluid and hydrocephalus
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