Kidney measures and cerebral white matter hyperintensity severity in chronic kidney disease stratified by type 2 diabetes mellitus status.

AIM: To investigate the association of kidney measures with Fazekas-defined white matter hyperintensity (WMH) severity in adults with chronic kidney disease (CKD), stratified by type 2 diabetes mellitus (T2DM) status.

METHODS

This retrospective cross-sectional study analyzed 1085 adults with CKD from the Taiwan Kidney Outcome (TAKO) cohort who underwent brain MRI between 2007 and 2021. WMH burden was assessed using the Fazekas scale. Multivariable proportional odds regression evaluated associations of eGFR, albuminuria category, and KDIGO risk category with WMH severity. Sensitivity analyses confirmed result robustness.

RESULTS

Among 1085 participants (615 with T2DM, 470 without), adjusted models revealed that albuminuria A3 was associated with higher periventricular WMH severity in both T2DM (OR, 2.46; 95 % CI, 1.49-4.10; P < 0.001) and non-T2DM groups (OR, 2.11; 95 % CI, 1.27-3.51; P = 0.004). Very high KDIGO risk also correlated with greater periventricular WMH severity in both groups. Lower eGFR was associated with higher periventricular and deep WMH severity specifically among participants with T2DM.

CONCLUSION

Albuminuria and KDIGO risk category are associated with greater periventricular WMH severity regardless of T2DM status. Lower eGFR is more consistently linked to WMH severity in T2DM patients. Longitudinal studies are required to clarify the clinical implications of these findings.