The Impact of Chronic Kidney Disease Stage on Intracranial Vascular Resistance

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 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. Disclosure: Dr. Ghoshal has nothing to disclose. Dr. Gomez has nothing to disclose. Dr. Freedman has nothing to disclose. Dr. Sarwal has nothing to disclose. Dr. Tegeler has nothing to disclose.