Purpose: Enlarged perivascular spaces (EPVS) are brain MRI markers of subclinical small vessel disease (SVD). Recent studies suggest that basal ganglia (BG) EPVS represent hypertensive vasculopathy, while centrum semiovale (CSO) EPVS represent cerebral amyloid angiopathy. Increasing evidence links chronic kidney disease (CKD) to SVD, but the relation to EPVS topography has not been studied, and data are lacking among racial groups. In this study, we explore the relationship between CKD and burden of EPVS across racial groups.
Methods: We included 894 consecutive stroke patients who underwent brain MRI admitted to an academic stroke center. EPVS were rated in the BG, and CSO following a standardized method, where severe burden of EPVS is considered when counts are 20 or greater. Race was assessed by self-report based on US census procedures and categorized as White, Black or Other racial groups (ORG). CKD was defined by past medical history or GFR < 60mL/min/1.73m2. We used multivariable logistic regression analysis to relate CKD and EPVS severity (mild [<20] vs severe [20 or greater]), adjusting for age, sex, hypertension, smoking and diabetes.
Results: CKD was present in 22% of the sample, in 17.7% Whites, 27.9% Blacks and 13.2% ORG. Severe EPVS prevalence for Whites, Blacks and ORG was for BG 19.6%, 18%, and 15.4%; and for CSO 38.8%, 42.6%, and 33.6%, respectively. In multivariate analysis, CKD was associated with severe EPVS in the CSO in the entire sample (OR 1.39, 95% CI 1, 1.94). The relation differed depending on EPVS topography and racial group. For BG, Whites had lower odds of severe EPVS compared to Blacks and ORG (OR 0.33, 9%% CI 0.12, 0.95), while for CSO, Whites with CKD had higher odds of severe EPVS (OR 2.18, 95% CI 1.03, 4.63).
Conclusion: CKD was associated with severity of EPVS in our sample of stroke patients. The relation differed across racial groups and by EPVS topography, suggesting that CKD may relate differently to the main forms of SVD (hypertensive and cerebral amyloid angiopathy) according to race. In Whites, the strong association of CKD with EPVS severity in the CSO may result from impaired amyloid clearance, but this hypothesis requires further study.