{
  "abstract": "Background Patients with chronic kidney disease are at increased risk of stroke and frequently have cerebral microbleeds. Whether such patients also encounter an increased risk of recurrent stroke has not been firmly established. We aimed to determine whether impaired kidney function is associated with the risk of recurrent stroke, and microbleed presence, distribution and severity.Methods We used pooled data from the Microbleeds International Collaborate Network to investigate associations of impaired kidney function, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2. Our primary outcome was a composite of recurrent ischaemic stroke (IS) and intracranial haemorrhage (ICrH). Secondary outcomes included: (1) individual components of the primary outcome; (2) modification of the primary outcome by microbleed presence or anticoagulant use and (3) microbleed presence, distribution and severity.Results 11 175 patients (mean age 70.7±12.6, 42% female) were included, of which 2815 (25.2%) had impaired kidney function. Compared with eGFR ≥60, eGFR <60 was associated with a higher risk of the primary outcome (adjusted HR, aHR 1.33 (95% CI 1.14 to 1.56), p<0.001) and higher rates of the recurrent IS (aHR 1.33 (95% CI 1.12 to 1.58)). Reduced eGFR was not associated with ICrH risk (aHR 1.07 (95% CI 0.70 to 1.60)). eGFR was also associated with microbleed presence (adjusted OR, aOR 1.14 (95% CI 1.03 to 1.26)) and severity (aOR 1.17 (95% CI 1.06 to 1.29)). Compared with having no microbleeds, eGFR was lower in those with strictly lobar microbleeds (adjusted mean difference (aMD) −2.10 mL/min/1.73 cm 2 (95% CI −3.39 to −0.81)) and mixed microbleeds (aMD −2.42 (95% CI −3.70 to −1.15)), but not strictly deep microbleeds (aMD −0.67 (95% CI −1.85 to 0.51)).Conclusions In patients with IS or transient ischaemic attack, impaired kidney function was associated with a higher risk of recurrent stroke and higher microbleeds burden, compared with those with normal kidney function. Further research is needed to investigate potential additional measures for secondary prevention in this high-risk group.",
  "authors": [
    {
      "affiliations": [
        "Department of Stroke & Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel",
        "Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel"
      ],
      "name": "Jeremy Molad"
    },
    {
      "affiliations": [
        "Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan"
      ],
      "name": "Kaori Miwa"
    },
    {
      "affiliations": [
        "Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, London, UK",
        "Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK"
      ],
      "name": "Philip S Nash"
    },
    {
      "affiliations": [
        "Department of Statistical Science, University College London, London, UK"
      ],
      "name": "Gareth Ambler"
    },
    {
      "affiliations": [
        "Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK"
      ],
      "name": "Jonathan Best"
    },
    {
      "affiliations": [
        "Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK"
      ],
      "name": "Duncan Wilson"
    },
    {
      "affiliations": [
        "Department of Stroke & Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel",
        "Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel"
      ],
      "name": "Hen Hallevi"
    },
    {
      "affiliations": [
        "Department of Neurology, Medical University of Graz, Graz, Austria"
      ],
      "name": "Simon Fandler-Höfler"
    },
    {
      "affiliations": [
        "Department of Neurology, Medical University of Graz, Graz, Austria"
      ],
      "name": "Sebastian Eppinger"
    },
    {
      "affiliations": [
        "Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK"
      ],
      "name": "Houwei Du"
    },
    {
      "affiliations": [
        "Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Rustam Al-Shahi Salman"
    },
    {
      "affiliations": [
        "Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK"
      ],
      "name": "Hans R Jäger"
    },
    {
      "affiliations": [
        "Liverpool Centre for Cardiovascular Science, Liverpool, UK"
      ],
      "name": "Gregory Y H Lip"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland"
      ],
      "name": "Martina B Goeldlin"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland",
        "Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA"
      ],
      "name": "Morin Beyeler"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland"
      ],
      "name": "Philipp Bücke"
    },
    {
      "affiliations": [
        "Institute of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland"
      ],
      "name": "Marwan El-Koussy"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland"
      ],
      "name": "Heinrich Paul Mattle"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland"
      ],
      "name": "Leonidas D Panos"
    },
    {
      "affiliations": [
        "Radiology and Nuclear Medicine & Neurology, Erasmus MC, Rotterdam, The Netherlands"
      ],
      "name": "Dianne H K van Dam-Nolen"
    },
    {
      "affiliations": [
        "Biomedical Imaging Group, Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands"
      ],
      "name": "Florian Dubost"
    },
    {
      "affiliations": [
        "Radiology, University Medical Center, Utrecht, The Netherlands"
      ],
      "name": "Jeroen Hendrikse"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, Maastricht, The Netherlands"
      ],
      "name": "M Eline Kooi"
    },
    {
      "affiliations": [
        "Department of Clinical Neurophysiology, Maastricht University Medical Centre+, Maastricht, The Netherlands"
      ],
      "name": "Werner Mess"
    },
    {
      "affiliations": [
        "Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Paul J Nederkoorn"
    },
    {
      "affiliations": [
        "Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan"
      ],
      "name": "Masayuki Shiozawa"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Wurzburg, Wurzburg, Germany"
      ],
      "name": "Nicolas Christ"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Wurzburg, Wurzburg, Germany"
      ],
      "name": "Maximilian Bellut"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Wurzburg, Wurzburg, Germany"
      ],
      "name": "Sarah Gunkel"
    },
    {
      "affiliations": [
        "Peninsula Clinical School, Peninsula Health, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Christopher Karayiannis"
    },
    {
      "affiliations": [
        "Monash Health and Stroke and Ageing Research Group, Monash University, Clayton, Victoria, Australia"
      ],
      "name": "John Van Ly"
    },
    {
      "affiliations": [
        "Monash Health and Stroke and Ageing Research Group, Monash University, Clayton, Victoria, Australia"
      ],
      "name": "Shaloo Singhal"
    },
    {
      "affiliations": [
        "Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia"
      ],
      "name": "Lee-Anne Slater"
    },
    {
      "affiliations": [
        "Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Young Dae Kim"
    },
    {
      "affiliations": [
        "Department of Neurology, Ewha Womans University, Seoul Hospital, Seoul, Korea (the Republic of)"
      ],
      "name": "Tae-Jin Song"
    },
    {
      "affiliations": [
        "Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea (the Republic of)"
      ],
      "name": "Keon-Joo Lee"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Ulsan College of Medicine, Songpa-gu, Korea (the Republic of)"
      ],
      "name": "Jae-Sung Lim"
    },
    {
      "affiliations": [
        "Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan"
      ],
      "name": "Hideo Hara"
    },
    {
      "affiliations": [
        "Department of Radiology, Saga University Faculty of Medicine, Saga, Japan"
      ],
      "name": "Masashi Nishihara"
    },
    {
      "affiliations": [
        "Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan"
      ],
      "name": "Jun Tanaka"
    },
    {
      "affiliations": [
        "Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan"
      ],
      "name": "Masaaki Yoshikawa"
    },
    {
      "affiliations": [
        "Department of Neurology, Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences, Istanbul, Turkey"
      ],
      "name": "Derya Selcuk Demirelli"
    },
    {
      "affiliations": [
        "Department of Neurology, Ministry of Health İzmir Katip Çelebi University Atatürk Education and Research Hospital, Izmir, Turkey"
      ],
      "name": "Zeynep Tanriverdi"
    },
    {
      "affiliations": [
        "Department of Radiology, Saglik Bilimleri Universitesi, Istanbul, Turkey"
      ],
      "name": "Ender Uysal"
    },
    {
      "affiliations": [
        "Neurosciences, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Shelagh B Coutts"
    },
    {
      "affiliations": [
        "UK Dementia Institute, University of Edinburgh Institute of Governance, Edinburgh, UK"
      ],
      "name": "Francesca M Chappell"
    },
    {
      "affiliations": [
        "Institute of Applied Health Sciences, University of Aberdeen, Old Perth Road, UK"
      ],
      "name": "Stephen Makin"
    },
    {
      "affiliations": [
        "Diagnostic Radiology, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong"
      ],
      "name": "Henry Ka-Fung Mak"
    },
    {
      "affiliations": [
        "Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Kay Cheong Teo"
    },
    {
      "affiliations": [
        "Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Debbie Y K Wong"
    },
    {
      "affiliations": [
        "Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Lisa Hert"
    },
    {
      "affiliations": [
        "Stroke Center Klinik Hirslanden Zürich, University of Basel, Basel, Switzerland"
      ],
      "name": "Marta Kubacka"
    },
    {
      "affiliations": [
        "Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Philippe Lyrer"
    },
    {
      "affiliations": [
        "Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Alexandros A Polymeris"
    },
    {
      "affiliations": [
        "Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Benjamin Wagner"
    },
    {
      "affiliations": [
        "Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Annaelle Zietz"
    },
    {
      "affiliations": [
        "Department of Radiology & Interventional Radiology, The Chinese University of Hong Kong, HongKong, China"
      ],
      "name": "Jill M Abrigo"
    },
    {
      "affiliations": [
        "Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong"
      ],
      "name": "Cyrus Cheng"
    },
    {
      "affiliations": [
        "Department of Radiology & Interventional Radiology, The Chinese University of Hong Kong, HongKong, China"
      ],
      "name": "Winnie C W Chu"
    },
    {
      "affiliations": [
        "Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Thomas W H Leung"
    },
    {
      "affiliations": [
        "Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Suk Fung Tsang"
    },
    {
      "affiliations": [
        "Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Brian Yiu"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland"
      ],
      "name": "David J Seiffge"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland"
      ],
      "name": "Urs Fischer"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland"
      ],
      "name": "Simon Jung"
    },
    {
      "affiliations": [
        "Department of Neurology, Medical University of Graz, Graz, Austria"
      ],
      "name": "Christian Enzinger"
    },
    {
      "affiliations": [
        "Department of Neurology, Medical University of Graz, Graz, Austria"
      ],
      "name": "Thomas Gattringer"
    },
    {
      "affiliations": [
        "Radiology and Nuclear Medicine & Neurology, Erasmus MC, Rotterdam, The Netherlands"
      ],
      "name": "Daniel Bos"
    },
    {
      "affiliations": [
        "Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan"
      ],
      "name": "Kazunori Toyoda"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Wurzburg, Wurzburg, Germany"
      ],
      "name": "Felix Fluri"
    },
    {
      "affiliations": [
        "Monash Health and Stroke and Ageing Research Group, Monash University, Clayton, Victoria, Australia"
      ],
      "name": "Thanh G Phan"
    },
    {
      "affiliations": [
        "Peninsula Clinical School, Peninsula Health, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Velandai Srikanth"
    },
    {
      "affiliations": [
        "Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Ji Hoe Heo"
    },
    {
      "affiliations": [
        "Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea (the Republic of)"
      ],
      "name": "Hee-Joon Bae"
    },
    {
      "affiliations": [
        "Department of Neurology, Kansai Medical University Medical Center, Hirakata, Japan"
      ],
      "name": "Yusuke Yakushiji"
    },
    {
      "affiliations": [
        "Department of Neurology, Istanbul Arel University, Istanbul, Turkey"
      ],
      "name": "Dilek Necioglu Orken"
    },
    {
      "affiliations": [
        "Neurosciences, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Eric E Smith"
    },
    {
      "affiliations": [
        "Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK",
        "UK Dementia Institute, University of Edinburgh Institute of Governance, Edinburgh, UK"
      ],
      "name": "Joanna M Wardlaw"
    },
    {
      "affiliations": [
        "Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Kui Kai Lau"
    },
    {
      "affiliations": [
        "Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland",
        "Neurology and Neurorehabilitation, Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland"
      ],
      "name": "Stefan T Engelter"
    },
    {
      "affiliations": [
        "Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland",
        "Neurology and Neurorehabilitation, Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland"
      ],
      "name": "Nils Peters"
    },
    {
      "affiliations": [
        "Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Yannie Soo"
    },
    {
      "affiliations": [
        "Department of Renal Medicine, University College London, London, UK"
      ],
      "name": "David C Wheeler"
    },
    {
      "affiliations": [
        "Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, London, UK",
        "Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK"
      ],
      "name": "Robert J Simister"
    },
    {
      "affiliations": [
        "Department of Stroke & Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel",
        "Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel"
      ],
      "name": "Natan M Bornstein"
    },
    {
      "affiliations": [
        "Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, London, UK",
        "Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK"
      ],
      "name": "David J Werring"
    },
    {
      "affiliations": [
        "Department of Stroke & Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel",
        "Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel",
        "Segol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel"
      ],
      "name": "Einor Ben Assayag"
    },
    {
      "affiliations": [
        "Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan"
      ],
      "name": "Masatoshi Koga"
    }
  ],
  "title": "Increased risk of recurrent stroke in patients with impaired kidney function: results of a pooled analysis of individual patient data from the MICON international collaboration",
  "uid": "28ac2f6a-efcc-5f7d-bffc-7481d17d6353"
}