Background: Chronic kidney disease (CKD) is a systemic microvascular disease with rapidly rising prevalence^[1–3]. Latest studies and emerging data suggest a strong relationship between CKD and cerebral small vessel disease (CSVD), which is a major contributor of cognitive impairment and stroke ^{[5,6,8,11,18,19,25,30]}. However, data from Indian population remains limited^[3,21,29].

Objectives: To determine the occurrence of cerebral small vessel disease in patients with chronic kidney disease and to identify various risk factors contributing to development of cerebral small vessel disease.

Methods: This hospital-based observational study included patients with diagnosed CKD patients of grade 3 and 4 according to KDIGO (Kidney Disease Improving Global Outcomes) criteria, aged 18 to 50 years attending a tertiary care centre in North India. All participants underwent detailed clinical evaluation, laboratory investigations including renal parameters, and magnetic resonance imaging (MRI) of the brain. CSVD markers—white matter hyperintensities (WMH), lacunes, cerebral microbleeds, and enlarged perivascular spaces—were assessed using standardized MRI criteria. Statistical analysis was performed to evaluate associations between CKD severity and CSVD burden.

Results: A significant proportion of CKD patients were demonstrated to have markers of CSVD on neuroimaging^{[18–21,25,26,37,39,40]}. The prevalence and severity of CSVD markers increased with declining estimated glomerular filtration rate (eGFR), increasing age and in patients with other comorbidities like hypertension and diabetes mellitus ^{[14,18,19,22,25,30,45]}. These were considered to be significant clinical and biochemical risk factors for the development of CSVD in CKD patients ^{[11,13,16,22,27,30]}.

Conclusion: CKD and CSVD are strongly associated thus supporting the concept of shared kidney–brain microvascular axis [5,11,17,22,27,28,30,44]. Early intervention to reduce the risk factors and early identification of CSVD in CKD patients may help in reducing the risk of vascular manifestation like stroke and cognitive impairment through planned preventive strategies ^{[10,17,18,25,32,54,62]}.

Keywords: Chronic kidney disease, cerebral small vessel disease, MRI brain, white matter hyperintensities, kidney–brain axis

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Dr. Arti Chaudhary

Department of Medicine, Sarojini Naidu Medical College, Agra