Associations of microalbuminuria with brain atrophy and white matter hyperintensities in hypertensive sibships

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Abstract

Background: Because of similarities between brain and kidney microvascular disease, there may be a relationship between measures of renal microvascular disease and brain structural changes in middle aged or elderly individuals. Objective: To determine whether the urine albumin/creatinine ratio (UACR), a measure of renal microvascular disease, is associated with brain atrophy and white matter hyperintensities. Methods: As part of a larger study of the genetics of hypertension, we performed brain imaging and assessed microalbuminuria and other vascular risk factors including diabetes, hypertension, hyperlipidemia and hyperhomocysteinemia in 1253 individuals from hypertensive sibships (age mean 63.8 years, range 50 to 91; 65% women; 49% African-American; 78% hypertensive). Semi-automated quantitative measurements of brain atrophy (BA) ventricular volume, and white matter hyperintensities (WMH) were carried out on the brain MR scans. Results: In logistic regression models, elevated UACR was associated with greater BA (odds ratio (OR) = 1.70 (95% CI 1.14, 2.54) and burden of WMH (OR = 2.06 (95% CI 1.37, 3.10) after controlling for demographic factors, blood glucose, hypertension severity, duration of smoking and serum homocysteine. In contrast to elevated UACR, the associations with elevated creatinine or reduced glomerular filtration rate and WMH were not significant in the fully adjusted models. Conclusions: In this cohort with an overrepresentation of hypertensives, elevated UACR was independently associated with both brain atrophy and white matter hyperintensities. Brain volume loss and WMH burden might represent expressions of microvascular disease that share common mechanisms with nephrosclerosis.

Original languageEnglish (US)
Pages (from-to)53-60
Number of pages8
JournalJournal of the Neurological Sciences
Volume271
Issue number1-2
DOIs
StatePublished - Aug 15 2008

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Atrophy
Creatinine
Brain
Albumins
Urine
Hypertension
Logistic Models
Odds Ratio
Nephrosclerosis
Kidney
Hyperhomocysteinemia
Kidney Diseases
Brain Diseases
Homocysteine
White Matter
Hyperlipidemias
Glomerular Filtration Rate
Neuroimaging
African Americans
Blood Glucose

Keywords

  • Brain
  • Diabetes
  • Hypertension
  • Magnetic resonance imaging
  • Microalbuminuria
  • Vascular risk factors

ASJC Scopus subject areas

  • Aging
  • Clinical Neurology
  • Surgery
  • Developmental Neuroscience
  • Neurology
  • Neuroscience(all)

Cite this

@article{28367d9bea0f4464b185270a6bfb180a,
title = "Associations of microalbuminuria with brain atrophy and white matter hyperintensities in hypertensive sibships",
abstract = "Background: Because of similarities between brain and kidney microvascular disease, there may be a relationship between measures of renal microvascular disease and brain structural changes in middle aged or elderly individuals. Objective: To determine whether the urine albumin/creatinine ratio (UACR), a measure of renal microvascular disease, is associated with brain atrophy and white matter hyperintensities. Methods: As part of a larger study of the genetics of hypertension, we performed brain imaging and assessed microalbuminuria and other vascular risk factors including diabetes, hypertension, hyperlipidemia and hyperhomocysteinemia in 1253 individuals from hypertensive sibships (age mean 63.8 years, range 50 to 91; 65{\%} women; 49{\%} African-American; 78{\%} hypertensive). Semi-automated quantitative measurements of brain atrophy (BA) ventricular volume, and white matter hyperintensities (WMH) were carried out on the brain MR scans. Results: In logistic regression models, elevated UACR was associated with greater BA (odds ratio (OR) = 1.70 (95{\%} CI 1.14, 2.54) and burden of WMH (OR = 2.06 (95{\%} CI 1.37, 3.10) after controlling for demographic factors, blood glucose, hypertension severity, duration of smoking and serum homocysteine. In contrast to elevated UACR, the associations with elevated creatinine or reduced glomerular filtration rate and WMH were not significant in the fully adjusted models. Conclusions: In this cohort with an overrepresentation of hypertensives, elevated UACR was independently associated with both brain atrophy and white matter hyperintensities. Brain volume loss and WMH burden might represent expressions of microvascular disease that share common mechanisms with nephrosclerosis.",
keywords = "Brain, Diabetes, Hypertension, Magnetic resonance imaging, Microalbuminuria, Vascular risk factors",
author = "Knopman, {David S} and Mosley, {Thomas H.} and Bailey, {Kent R} and Jack, {Clifford R Jr.} and Schwartz, {Gary Lee} and Turner, {Stephen T}",
year = "2008",
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doi = "10.1016/j.jns.2008.03.009",
language = "English (US)",
volume = "271",
pages = "53--60",
journal = "Journal of the Neurological Sciences",
issn = "0022-510X",
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TY - JOUR

T1 - Associations of microalbuminuria with brain atrophy and white matter hyperintensities in hypertensive sibships

AU - Knopman, David S

AU - Mosley, Thomas H.

AU - Bailey, Kent R

AU - Jack, Clifford R Jr.

AU - Schwartz, Gary Lee

AU - Turner, Stephen T

PY - 2008/8/15

Y1 - 2008/8/15

N2 - Background: Because of similarities between brain and kidney microvascular disease, there may be a relationship between measures of renal microvascular disease and brain structural changes in middle aged or elderly individuals. Objective: To determine whether the urine albumin/creatinine ratio (UACR), a measure of renal microvascular disease, is associated with brain atrophy and white matter hyperintensities. Methods: As part of a larger study of the genetics of hypertension, we performed brain imaging and assessed microalbuminuria and other vascular risk factors including diabetes, hypertension, hyperlipidemia and hyperhomocysteinemia in 1253 individuals from hypertensive sibships (age mean 63.8 years, range 50 to 91; 65% women; 49% African-American; 78% hypertensive). Semi-automated quantitative measurements of brain atrophy (BA) ventricular volume, and white matter hyperintensities (WMH) were carried out on the brain MR scans. Results: In logistic regression models, elevated UACR was associated with greater BA (odds ratio (OR) = 1.70 (95% CI 1.14, 2.54) and burden of WMH (OR = 2.06 (95% CI 1.37, 3.10) after controlling for demographic factors, blood glucose, hypertension severity, duration of smoking and serum homocysteine. In contrast to elevated UACR, the associations with elevated creatinine or reduced glomerular filtration rate and WMH were not significant in the fully adjusted models. Conclusions: In this cohort with an overrepresentation of hypertensives, elevated UACR was independently associated with both brain atrophy and white matter hyperintensities. Brain volume loss and WMH burden might represent expressions of microvascular disease that share common mechanisms with nephrosclerosis.

AB - Background: Because of similarities between brain and kidney microvascular disease, there may be a relationship between measures of renal microvascular disease and brain structural changes in middle aged or elderly individuals. Objective: To determine whether the urine albumin/creatinine ratio (UACR), a measure of renal microvascular disease, is associated with brain atrophy and white matter hyperintensities. Methods: As part of a larger study of the genetics of hypertension, we performed brain imaging and assessed microalbuminuria and other vascular risk factors including diabetes, hypertension, hyperlipidemia and hyperhomocysteinemia in 1253 individuals from hypertensive sibships (age mean 63.8 years, range 50 to 91; 65% women; 49% African-American; 78% hypertensive). Semi-automated quantitative measurements of brain atrophy (BA) ventricular volume, and white matter hyperintensities (WMH) were carried out on the brain MR scans. Results: In logistic regression models, elevated UACR was associated with greater BA (odds ratio (OR) = 1.70 (95% CI 1.14, 2.54) and burden of WMH (OR = 2.06 (95% CI 1.37, 3.10) after controlling for demographic factors, blood glucose, hypertension severity, duration of smoking and serum homocysteine. In contrast to elevated UACR, the associations with elevated creatinine or reduced glomerular filtration rate and WMH were not significant in the fully adjusted models. Conclusions: In this cohort with an overrepresentation of hypertensives, elevated UACR was independently associated with both brain atrophy and white matter hyperintensities. Brain volume loss and WMH burden might represent expressions of microvascular disease that share common mechanisms with nephrosclerosis.

KW - Brain

KW - Diabetes

KW - Hypertension

KW - Magnetic resonance imaging

KW - Microalbuminuria

KW - Vascular risk factors

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VL - 271

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JO - Journal of the Neurological Sciences

JF - Journal of the Neurological Sciences

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