CEREBRAL small vessel disease burden was associated with poorer kidney function and albuminuria in older adults, according to a cross-sectional study of 239 participants who underwent brain magnetic resonance imaging and kidney assessment.
The study assessed total cerebral small vessel disease burden using a score ranging from zero to four. The score incorporated severe white matter hyperintensities, lacunes, deep microbleeds and moderate to severe enlarged basal ganglia perivascular spaces.
Kidney health was assessed using eGFR, serum creatinine, cystatin C and urinary albumin to creatinine ratio (UACR). The findings showed that greater cerebral small vessel disease burden was associated with multiple measures of kidney dysfunction.
After full adjustment for confounding factors, each one-point increase in cerebral small vessel disease score was associated with a reduction in eGFR: β=-2.98; 95% CI: -4.67–-1.29.
Higher cerebral small vessel disease scores were also associated with increases in serum creatinine: β=0.14; 95% CI: 0.04–0.24, cystatin C: β=0.06; 95% CI: 0.02–0.10, and ln(UACR): β=0.24; 95% CI: 0.12–0.36. All associations had p≤0.007.
The cerebral small vessel disease score was additionally associated with composite kidney dysfunction: odds ratio: 1.38; 95% CI: 1.08–1.76, and albuminuria: odds ratio=1.46; 95% CI: 1.12–1.90. However, the association with reduced eGFR was not statistically significant: p=0.068.
Further analysis indicated that hypertension may have contributed substantially to the relationship between cerebral small vessel disease and kidney measures. Additional adjustment for hypertension partially attenuated the observed associations.
Exploratory mediation analysis estimated that hypertension accounted for 32.0%–36.7% of the associations between cerebral small vessel disease burden and kidney outcomes. The researchers noted that this finding requires confirmation in prospective studies.
Overall, the findings indicate that greater MRI defined cerebral small vessel disease burden was associated with worse kidney function and albuminuria after adjustment for multiple confounders. The results also suggest a potential shared role for hypertensive microvascular injury in the relationship between cerebral and renal health.
Because the study was cross sectional, the findings demonstrate an association rather than causation. Prospective research will be required to determine whether the observed relationship persists over time and to clarify the contribution of hypertension.
Su Z et al. Association of MRI-defined total burden of cerebral small vessel disease with multiple kidney function measures in older adults: a cross-sectional study. Sci Rep. 2026;DOI;10.1038/s41598-026-67125-5.
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