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Albuminuria and Cerebral Small Vessel Disease: A Systematic Review and Meta‐Analysis
Author(s) -
Georgakis Marios K.,
Chatzopoulou Despoina,
Tsivgoulis Georgios,
Petridou Eleni Th.
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15240
Subject(s) - medicine , odds ratio , hyperintensity , confidence interval , albuminuria , meta analysis , population , cardiology , magnetic resonance imaging , disease , radiology , environmental health
Objectives To determine whether albuminuria, a marker of systemic endothelial dysfunction, is associated with cerebral small vessel disease ( SVD ). Design Systematic review following the Meta‐analyses Of Observational Studies in Epidemiology guidelines; independent reviewers searched Pubmed/Medline and Scopus, data were extracted, studies were evaluated on quality, and random‐effects models were implemented for meta‐analysis. Setting Observational studies quantifying an association between albuminuria and cerebral SVD . Participants Adults. Measurements Magnetic resonance imaging–defined markers of cerebral SVD ; white matter hyperintensities ( WMH s), lacunar infarcts ( LI s), cerebral microbleeds ( CMB s), and enlarged perivascular spaces ( EPVS s). Results Of 31 eligible studies comprising 23,056 participants identified, 27 were included in quantitative synthesis. Most of the studies were cross‐sectional and of varying quality. On meta‐analysis, albuminuria was associated with greater risk of WMH s (odds ratio ( OR ) = 1.70, 95% confidence interval ( CI ) = 1.43–2.01; 13,548 subjects, 2,665 cases; I 2 = 44%), LI s ( OR = 1.86, 95% CI = 1.49–2.31; 12,857 subjects, 998 cases; I 2 = 27%), CMB s ( OR = 1.78, 95% CI = 1.30–2.43; 7,645 subjects; 748 cases; I 2 = 39%), and EPVS s in the basal ganglia ( OR = 1.78, 95% CI = 1.02–3.09; 1,388 subjects, 399 cases; I 2 = 37%) and centrum semiovale ( OR = 3.27, 95% CI = 1.49–7.20; 1,146 subjects, 460 cases; I 2 = 66%). Sensitivity analyses for high‐quality and general population studies, but also studies controlling for cardiovascular disease risk factors and renal function, confirmed the findings and resolved the moderate heterogeneity and publication bias that were evident in the overall analyses. Conclusion Albuminuria is independently associated with cerebral SVD , indicating shared microvascular pathology in the kidney and the brain. The results suggest that peripheral systemic microvascular disease biomarkers could be useful in the evaluation of brain microvascular damage.