Abstract Details

Title The Impact of Chronic Kidney Disease Stage on Intracranial Vascular Resistance

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-066

Objective

To assess the effect of CKD stage on cerebral hemodynamics in acute post-stroke patients with CKD stages 1-5 by Transcranial Doppler (TCD).

Background Individuals with chronic kidney disease (CKD) have a graded, independent relationship between disease stage and stroke risk. CKD stage’s effect on cerebral hemodynamics is unknown.

Design/Methods After IRB approval, records of all acute stroke patients admitted to a single tertiary care center from 2015-2017 were reviewed. Patients who received TCD within one month following stroke were identified. TCD data included averaged mean flow velocities (MFV) and pulsatility index (PI) for the bilateral middle cerebral arteries (MCA), anterior cerebral arteries (ACA), posterior cerebral arteries (PCA) and vertebral arteries (VA). Patients with significant unilateral intracranial stenosis were excluded. CKD stages were determined by stable serum creatinine and CKD-Epi eGFR equation over three months.

Results The analysis included 143 patients, mean age 62.5 years, 47.8% male. CKD classes did not differ significantly in age, gender, or intracranial atherosclerosis. Among patients with CKD stage 1 (CKD1; n=53), MCA MFV was 60.8+21.9/PI 0.92+0.23, ACA MFV 54.2+18.2/PI 0.91+0.21, PCA MFV 38.9+14.2/PI 0.92+0.2, and VA MFV 31.7+9.8/ PI 1.01+0.24. Patients with CKD2 showed significantly decreased MFVs and higher PIs throughout, compared to those with CKD1. Among CKD2 patients (n=51), MCA MFV was 51.3+15.1/PI 1.06+0.25, ACA MFV 45.4+11.7/PI 1.07+0.25, PCA MFV 32.3+9.4/PI 1.05+0.3, and VA MFV 27.4+8.9/PI VA 1.1+0.27. These significant differences in MFV and PI (all p<0.05) persisted in CKD stages 3, 4 and 5, when compared to CKD1. CKD2 patients did not differ significantly from CKD3-5 patients by these TCD metrics.

Conclusions These data suggest distal resistance indices and mean flow velocities increase at the early stage CKD2 and persist in advanced CKD stages. Further research regarding TCD cerebral hemodynamics and its effect on stroke burden in CKD patients is needed.

Authors/Disclosures
Shivani Ghoshal, MD (Columbia University Medical Center) PRESENTER	Dr. Ghoshal has nothing to disclose.
	No disclosure on file
	No disclosure on file
Aarti Sarwal, MD, FAAN	Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stimdia, Inc. Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Consultant for Sheinkei. Dr. Sarwal has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Society of Critical Care Medicine . Dr. Sarwal has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Society of Neuroimaging . The institution of Dr. Sarwal has received research support from Butterfly, Inc. The institution of Dr. Sarwal has received research support from Bard. The institution of Dr. Sarwal has received research support from Biogen. The institution of Dr. Sarwal has received research support from Novartis. The institution of Dr. Sarwal has received research support from CVR Global. The institution of Dr. Sarwal has received research support from NIH/NIA R01 AG066910-01 . The institution of Dr. Sarwal has received research support from Image Monitoring. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker/Faculty, CME courses with Society of Critical Care Medicine . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Intensive Care Society. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Indian Society of Critical Care. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a speaker/Faculty for Annual meeting, travel compensation with European Society of Intensive Care Medicine. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker with ISICEM. Dr. Sarwal has a non-compensated relationship as a Social Media Editor with Neurocritical Care that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Secretary with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a President with Association of Indian Neurologists in America that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Member, Board of Directors with Neurocritical Care Society that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Section Chair, Neurosciences Section with Society of Critical Care Medicine that is relevant to AAN interests or activities.
Charles H. Tegeler, MD (Wake Forest School of Medicine)	Dr. Tegeler has nothing to disclose.

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