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LONG-TERM PROGNOSTIC IMPLICATIONS OF BRAIN IMAGING FINDINGS IN
PATIENTS WITH END STAGE RENAL FAILURE
Findlay, MD, Dawson, J, Patel, RK, Jardine, AG, Thomson, PC, Mark, PB
Renal and Transplant Unit, Western Infirmary, Glasgow
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow
INTRODUCTION: Survival in patients with end stage renal failure (ESRF) is reduced and
risk of cardiovascular disease, including stroke, is greatly increased. As a result, brain imaging
(computed tomography (CT) and magnetic resonance imaging (MRI)) are commonly
performed. This will detect cases of incident stroke but also other common findings such as
atrophy and small vessel ischaemic change. We studied the prognostic implications of findings
on brain imaging in a cohort of patients with ESRF.
METHODS: The electronic patient record was used to identify all prevalent patients on renal
replacement therapy (RRT) for ESRF between 01/01/2007 and 31/12/2012 (total cohort 2228
patients). Demographic data, modality and result of first brain imaging were recorded. Results
were classified as either normal, territorial infarction (TI), small vessel disease (SVD), cerebral
atrophy, intracranial bleed (ICH) or other, based on radiologist’s report. Date and cause of death
were recorded and patients were censored on 05/12/2013.
RESULTS: During this period 328 patients underwent brain imaging (mean age at time of
imaging 64.0 (SD 14.2) years, 54.6% male; first RRT modality haemodialysis 81.4%, peritoneal
dialysis 17.1%, transplant 1.5%). The first imaging modality was CT in 290 cases (88.4%), MRI
in 37 (11.3%) and SPECT in 1 (0.3%). Imaging diagnosis was normal in 75 (22.9%), TI in 57
(17.4), SVD in 144 (43.9%), atrophy in 35 (10.7%), bleed in 8 (2.4%) and other in 9 (2.7%).
There were 172 deaths during follow up (cardiovascular cause in 45 (26.2 %), malignancy in 7
(4%), infection in 34 (19.8%), other in 23 (13.4%) and unknown in 63 (36.6%)). Patients who
died were older (68.1 vs. 59.4 years, p<0.001) and had a greater prevalence of atrial fibrillation
(23.3% vs. 9.6%, p<0.01). Compared to patients with normal scans, patients with atrophy, SVD,
TI and bleed had significantly poorer outcome (Figure 1). Age, atrial fibrillation and brain
imaging findings were significant independent predictors of reduced survival on multivariate
analysis.
Figure 1. Kaplan-Meier
survival curve showing
survival following brain
imaging with significance
by Log-rank test
CONCLUSION: Brain imaging diagnosis predicted long-term prognosis in ESRF. Stroke (TI
or ICH) predicted worst prognosis but findings compatible with small vessel ischaemic damage,
which is not currently treated, also predicted worse prognosis. Strategies for risk reduction in
this group should be explored.