Asymptomatic Cerebrovascular Disease in Dialysis Patients.

Cerebrovascular disease is a major cause of death in dialysis patients, who have a much higher incidence of stroke compared to the normal population. Recent studies have shown that asymptomatic cerebral small-vessel disease, including silent brain infarction (SBI), white matter hyperintensities (WMHs), and cerebral microbleeds (CMBs), is related to the future onset of stroke. Cerebral small-vessel disease is caused by microvascular damage to the small penetrating arteries of the middle cerebral artery including arteriolosclerosis, fibrinoid necrosis, and lipohyalinosis attributed to advanced age, hypertension, etc. SBI is thought to occur due to cerebral small vessel occlusion caused by vascular necrosis, CMB vascular breakdown caused by vascular fragility, and WMH chronic ischemia caused by decreased perfusion. Because small-vessel disease is more prevalent in dialysis patients compared with the normal population, further evidence on small-vessel disease needs to be accumulated in order to prevent future strokes in these patients.