The purpose of this study is to investigate the correlation and its clinical value between the severity of chronic kidney disease and cerebral arterial blood flow dynamics by transcranial color-coded duplex sonography (TCCD). We collected patients with cerebral small vessel disease with chronic kidney disease (CKD) who visited Hongqi Hospital affiliated with Mudanjiang Medical University, gathered between October 2020 and December 2021. The results were analyzed and then divided into 3 groups according to different stages of CKD: 73 patients in CKD stage Ⅰ-Ⅲ, CKD-IV, and CKD-V.Those with stable serum creatinine and small cerebral vascular lesions without stenosis or occlusion of intracranial large vessels were examined by TCCD. The spectrum data of intracranial great vessels of the three groups were measured and the vascular resistance index (RI) and pulsatility index (PI) were calculated. The obtained data were analyzed statistically. Finally, it is concluded that: ①There was no significant difference in general data (gender and age) among the 3 groups (p>0.05); ②There was no statistically significant difference between the bilateral anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) RI and PI values in the three groups (p>0.05).③There were no significant differences in ACA-PI and PCA-PI values among the three groups (p > 0.05). Each of the three groups' MCA-PI levels corresponded to a different stage of CKD in the patients. Patients with stage V CKD had PI levels that were noticeably greater than those of patients with stages I–III and IV. ④At various stages of CKD, there was a linear relationship between the MCA-PI value and serum creatinine level; also, the MCA-PI value increased linearly as the serum creatinine level increased. To sum up, TCCD has certain clinical application value for stroke risk assessment in CKD patients with small cerebral vessel diseases. It can capture the small cerebral blood flow changes in CKD patients at an early stage, non-invasive assessment of potential stroke probability in CKD patients, and help clinical physicians intervene early to lower the incidence and death of cerebrovascular disorders in patients with chronic kidney disease.

Huiting Fang, Shuang Wang, Shichao Liu, Yujie Li, Yin Zhang, Shumei Shan, Kemin Xi, Yue Qiao, Yue Li. To Explore the Correlation between the Severity of Chronic Kidney Disease and the Hemodynamics of Small Cerebral Vessels under Transcranial Color Doppler. Academic Journal of Medicine & Health Sciences (2024), Vol. 5, Issue 2: 22-29. https://doi.org/10.25236/AJMHS.2024.050204.

[1] Oh ES, Freeberg KA, Steele CN, Wang W, Farmer-Bailey H, Coppock ME, Seals DR, Chonchol M, Rossman MJ, Craighead DH, Nowak KL. Cerebrovascular pulsatility index is higher in chronic kidney disease. Physiol Rep. 2023 Jan;11(1):e15561. 

[2] Zoccali C, Vanholder R, MassyZAet al.  European Renal and Cardiovascular Medicine (EURECA-m) Working Group of the European Renal Association – European Dialysis Transplantation Association (ERA-EDTA). The systemic nature of CKD. Nat Rev Nephrol, 2017; 13: 344–358

[3] Seliger S L, Weiner D E. Cognitive Impairment in Dialysis Patients: Focus on the Blood Vessels?[J]. American Journal of Kidney Diseases the Official Journal of the National Kidney Foundation, 2013, 61(2): 187-190.

[4] Briet M,Bozec E,Laurent S,et al. Arterial stiffness and enlargement in mild-to-moderate chronic kidney disease[J]. Kidney International,2006,69(2):350-357.

[5] K.-Y. P, P.-W. C, Kim Y B, et al. Increased pulsatility index is associated with intracranial arterial calcification.[J]. European Neurology, 2013,69(2):83-88. 

[6] Weiner D E,Scott T M,Giang L M,et al. Cardiovascular Disease and Cognitive Function in Maintenance Hemodialysis Patients[J]. American Journal of Kidney Diseases, 2011,58(5):773-781.

[7] Coresh J, Astor BC, Mcquillan G, et al. Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate[J]. American Journal of Kidney Diseases, 2002,39(5):920-929.

[8] Powers W J, Rabinstein A A, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Journal of Vascular Surgery, 2018,67(6):1934.

[9] Brain ultrasonography: methodology, basic and advanced principles, and clinical applications. A narrative review.[J]. Intensive care medicine, 2019. 45(7):913-927

[10] Xu Lei, Kang Yaning, Ma Jing, Yang Yuanyuan, Huang Lizhen, Wang Rongrong, Cui Xiaoyuan. Diagnostic value of Doppler ultrasonography for cardiovascular changes in patients with chronic renal insufficiency [J]. Chinese Journal of Medical Physics, 2019, 36(12):1440-1443. 

[11] Robba C, Goffi A, Geeraerts T, et al. Brain ultrasonography: methodology, basic and advanced principles and clinical applications: a narrative review. Intensive CareMed 2019; 45: 913–927.

[12] Robba Chiara,Cardim Danilo,Tajsic Tamara et al. Non-invasive Intracranial Pressure Assessment in Brain Injured Patients Using Ultrasound-Based Methods.[J].Acta Neurochir Suppl, 2018, 126: 69-73. 

[13] Sharon M L, Sharma V K, Rudolf K. Role of Transcranial Doppler in the Evaluation of Vasculopathy in Tuberculous Meningitis[J]. Plos One,2016,11(10):e0164266.

[14] Lee E J, Jeong H B, Bae J, et al. Renal Dysfunction Is Associated with Middle Cerebral Artery Pulsatility Index and Total Burden of Cerebral Small Vessel Disease [J]. Cerebrovascular diseases (Basel, Switzerland), 2021;50(6):722-728.

[15] Herzog C A,Asinger R W,Berger A K,et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO)[J]. Kidney International, 2011, 80(6):572-586.

[16] Arnold R, Issar T, Krishnan A V, et al. Neurological complications in chronic kidney disease[J]. Jrsm Cardiovascular Disease, 2016, 5:2048004016677687.

[17] Ghoshal Shivani, Gomez Jonathan, Datar Sudhir V, et al. The impact of chronic kidney disease on cerebral hemodynamics: A transcranial Doppler study. [J]. J Cereb Blood Flow Metab,2020,40: 482-487.

[18] Xie Juanjuan, Chen Hongtian, Ao Kun, Zhang Ping, Long Xiangdang. Evaluation of cerebral arteriosclerosis in patients with rheumatoid arthritis by transcranial color bifunctional ultrasound [J]. Journal of Clinical Ultrasound Medicine, 2019, 21(12):948-950 

[19] Sedaghat S, Vernooij MW, Loehrer E, Mattace-Raso FU, Hofman A, van der Lugt A, Franco OH, Dehghan A, Ikram MA. Kidney Function and Cerebral Blood Flow: The Rotterdam Study. J Am Soc Nephrol. 2016 Mar; 27(3):715-721. 

[20] Seliger SL, Siscovick DS, Stehman-Breen CO, Gillen DL, Fitzpatrick A, Bleyer A, Kuller LH. Moderate renal impairment and risk of dementia among older adults: the Cardiovascular Health Cognition Study. J Am Soc Nephrol. 2004 Jul; 15(7):1904-1911.