Research Article

Silent Brain Lesions in Chronic Kidney Disease: A Hidden Burden

Volume: 8 September 8, 2026

Silent Brain Lesions in Chronic Kidney Disease: A Hidden Burden

Abstract

Objective: Silent brain lesions (SBL), including silent brain infarction (SBI) and subcortical white matter lesions (SWML), are increasingly recognized as important radiological markers of cerebral small vessel disease. Patients with chronic kidney disease (CKD) may be at increased risk due to shared vascular and metabolic abnormalities. This study aimed to investigate the prevalence, radiological characteristics, and predictors of SBL in patients with CKD.

Methods: This retrospective study included 276 patients with CKD who underwent brain magnetic resonance imaging (MRI) between March 2020 and March 2021. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m², and patients undergoing hemodialysis were included. MRI findings were classified as SBI, SWML, overt stroke, or no lesion. Silent brain lesions were defined as the presence of SBI and/or SWML in patients without a clinical history of stroke or focal neurological deficits. Clinical and laboratory data were analyzed, and independent predictors were determined using binary logistic regression.

Results: Pathological MRI findings were detected in 177 patients (64.1%). Among them, 131 patients (74.0%) had SBL (73 SWML and 58 SBI), while 46 (26.0%) had overt stroke. Patients with SBL were older and had a higher prevalence of diabetes mellitus and hypertension compared with those with overt stroke. In multivariate logistic regression analysis, older age (OR: 1.073, 95% CI: 1.051–1.096; p < 0.001) and higher serum creatinine levels (OR: 1.306, 95% CI: 1.096–1.557; p = 0.003) were identified as independent predictors of SBL. Among patients with SBL, those with SWML had a longer duration of hemodialysis compared to those with SBI.

Conclusion: Silent brain lesions are highly prevalent in patients with CKD. Older age and impaired renal function are independent predictors of SBL. These findings highlight the importance of cerebrovascular risk assessment in CKD patients, particularly in older individuals and those with advanced renal dysfunction.

Keywords

Ethical Statement

The study was approved by the Ethics Committee of Necmettin Erbakan University, Meram School of Medicine (Approval No. 2020/2480). Written informed consent was obtained from all participants.

References

  1. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7):689-701. doi:10.1016/S1474-4422(10)70104-6.
  2. Wardlaw JM, Smith C, Dichgans M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol. 2013;12(5):483-97. doi:10.1016/S1474-4422(13)70060-7.
  3. Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. 2010;341:c3666. doi:10.1136/bmj.c3666.
  4. Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007;6(7):611-9. doi:10.1016/S1474-4422(07)70170-9.
  5. Longstreth WT Jr, Manolio TA, Arnold A, Burke GL, Bryan N, Jungreis CA, et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people: the Cardiovascular Health Study. Stroke. 1996;27(8):1274-82. doi:10.1161/01.STR.27.8.1274.
  6. Schmidt R, Fazekas F, Kapeller P, Schmidt H, Hartung HP. MRI white matter hyperintensities: three-year follow-up of the Austrian Stroke Prevention Study. Neurology. 1999;53(1):132-139. doi:10.1212/WNL.53.1.132.
  7. Iadecola C, Davisson RL. Hypertension and cerebrovascular dysfunction. Cell Metab. 2008;7(6):476-84. doi:10.1016/j.cmet.2008.03.010.
  8. Etgen T, Sander D, Chonchol M, Briesenick C, Poppert H, Förstl H, et al. Chronic kidney disease is associated with incident cognitive impairment in the elderly: the INVADE study. Nephrol Dial Transplant. 2009;24(10):3144-50. doi:10.1093/ndt/gfp230.

Details

Primary Language

English

Subjects

Nefroloji

Journal Section

Research Article

Publication Date

September 8, 2026

Submission Date

November 28, 2025

Acceptance Date

August 31, 2026

Published in Issue

Year 2026 Volume: 8

APA
Baloğlu, İ., Öztürk, Y., Elbistan, C. F., Oruç, M., Erçin, M. B., Ozer, H., Yönet, F., Kozak, H. H., Emlik, G. D., Selçuk, N. Y., Tonbul, H. Z., & Türkmen, K. (2026). Silent Brain Lesions in Chronic Kidney Disease: A Hidden Burden. Turkish Journal of Internal Medicine, 8, 164-173. https://doi.org/10.46310/tjim.1820171
AMA
1.Baloğlu İ, Öztürk Y, Elbistan CF, et al. Silent Brain Lesions in Chronic Kidney Disease: A Hidden Burden. Turk J Int Med. 2026;8:164-173. doi:10.46310/tjim.1820171
Chicago
Baloğlu, İsmail, Yasin Öztürk, Cemile Feyza Elbistan, et al. 2026. “Silent Brain Lesions in Chronic Kidney Disease: A Hidden Burden”. Turkish Journal of Internal Medicine 8 (September): 164-73. https://doi.org/10.46310/tjim.1820171.
EndNote
Baloğlu İ, Öztürk Y, Elbistan CF, Oruç M, Erçin MB, Ozer H, Yönet F, Kozak HH, Emlik GD, Selçuk NY, Tonbul HZ, Türkmen K (September 1, 2026) Silent Brain Lesions in Chronic Kidney Disease: A Hidden Burden. Turkish Journal of Internal Medicine 8 164–173.
IEEE
[1]İ. Baloğlu et al., “Silent Brain Lesions in Chronic Kidney Disease: A Hidden Burden”, Turk J Int Med, vol. 8, pp. 164–173, Sept. 2026, doi: 10.46310/tjim.1820171.
ISNAD
Baloğlu, İsmail - Öztürk, Yasin - Elbistan, Cemile Feyza - Oruç, Merve - Erçin, Mehmet Burak - Ozer, Hakan - Yönet, Fethi et al. “Silent Brain Lesions in Chronic Kidney Disease: A Hidden Burden”. Turkish Journal of Internal Medicine 8 (September 1, 2026): 164-173. https://doi.org/10.46310/tjim.1820171.
JAMA
1.Baloğlu İ, Öztürk Y, Elbistan CF, Oruç M, Erçin MB, Ozer H, Yönet F, Kozak HH, Emlik GD, Selçuk NY, Tonbul HZ, Türkmen K. Silent Brain Lesions in Chronic Kidney Disease: A Hidden Burden. Turk J Int Med. 2026;8:164–173.
MLA
Baloğlu, İsmail, et al. “Silent Brain Lesions in Chronic Kidney Disease: A Hidden Burden”. Turkish Journal of Internal Medicine, vol. 8, Sept. 2026, pp. 164-73, doi:10.46310/tjim.1820171.
Vancouver
1.İsmail Baloğlu, Yasin Öztürk, Cemile Feyza Elbistan, Merve Oruç, Mehmet Burak Erçin, Hakan Ozer, Fethi Yönet, Hasan Hüseyin Kozak, Ganime Dilek Emlik, Nedim Yılmaz Selçuk, Halil Zeki Tonbul, Kültigin Türkmen. Silent Brain Lesions in Chronic Kidney Disease: A Hidden Burden. Turk J Int Med. 2026 Sep. 1;8:164-73. doi:10.46310/tjim.1820171

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