Elevated Lipoprotein(a) is Independently Associated with Deep Cerebral Microbleeds in Patients with Chronic Kidney Disease: A Retrospective Observational Study.

OBJECTIVE: This study aimed to investigate the independent association between plasma Lipoprotein(a) [Lp(a)] levels and the occurrence, anatomical distribution, and severity of cerebral microbleeds (CMBs) in patients with Chronic kidney disease (CKD). METHODS: A single-center retrospective observational cohort enrolled 137 CKD patients admitted from January 2022 to January 2026. All subjects completed 3.0T MRI with susceptibility-weighted imaging (SWI) for CMBs identification and regional stratification (cortical, deep, subcortical). Clinical demographics, and serum lipid levels including Lp(a) were collected. Univariate comparisons, binary logistic regression, ROC curve analysis, Spearman and partial correlation analyses were performed to assess associations between Lp(a) and CMBs. RESULTS: The overall occurrence of CMBs in the cohort was 58.39%. Patients with CMBs had significantly higher plasma Lp(a) levels than those without CMBs (40.23±113.56 mg/dL vs 8.83±11.88 mg/dL, P=0.040). After adjustment, binary logistic regression analysis indicated that elevated Lp(a) was independently associated with global CMBs (Odds Ratio [OR]=1.052, 95% Confidence Interval [CI] = 1.020-1.086, P = 0.001) and deep CMBs (Odds Ratio [OR] = 1.034, 95% Confidence Interval [CI] =1.015-1.054, P < 0.001), but not with cortical or subcortical CMBs. The area under the ROC curve (AUC) of Lp(a) was 0.728, with an optimal cutoff value of 14.055 mg/dL (sensitivity = 0.590, specificity = 0.829). Lp(a) was positively related to deep CMBs severity across all CKD patients (partial correlation coefficient = 0.253, P=0.003), while this association was not significant among patients with CMBs. CONCLUSION: Elevated plasma Lp(a) is an independent risk factor for CMBs in patients with CKD, with a specific anatomical predilection for deep cerebral lesions. It may serve as a potential serologic marker for cerebrovascular risk stratification among patients with CKD.