Chronic kidney disease and intravenous thrombolysis in acute stroke: A systematic review and meta-analysis

Jung, Jun‐Sub; Kim, Hyun Jung; Ahn, Hyeong Sik; Ahn, Il Min; Do, Young-Rok; Choi, Jeong Yoon; Seo, Woo Keun; Oh, Kyungmi; Cho, Kyung Hee; Yu, Sungwook

doi:10.1016/j.jns.2015.09.353

Cited by 39 publications

(27 citation statements)

References 30 publications

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“…In a pooled analysis of 7 observational studies (7168 patients), IVT-treated patients with CKD had a higher risk of symptomatic intracerebral hemorrhage (ICH) and mortality (pooled odds ratio [OR], 1.56; 95% CI, 1.05-2.33 and pooled OR, 1.70; 95% CI, 1.03-2.81, respectively). 83 Patients with CKD also had an increased risk of poor functional outcomes at 3 months. The interpretation of this meta-analysis is limited, however, by heterogeneity, lack of detail on the effect of IVT dose or time window, and lack of comparative data on outcomes in patients not given IVT.…”

Section: Acute Stroke Treatments In Ckd Thrombolysismentioning

confidence: 99%

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Kelly

Rothwell

2020

Kidney International

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Chronic kidney disease is strongly associated with an increased risk of stroke, small vessel disease, and vascular dementia. Common vascular factors for stroke, such as hypertension, diabetes, and atrial fibrillation, are more prevalent in patients with chronic kidney disease, accounting for this association. However, factors unique to these patients, such as uremia, oxidative stress, and mineral and bone abnormalities, as well as dialysis-related factors are also believed to contribute to risk. Despite improvements in stroke treatment and survival in the general population, the rate of improvement in patients with chronic kidney disease, especially those who are dialysis dependent, has lagged behind. There is a lack of or conflicting evidence that those with renal disease, particularly when advanced or older, consistently derive benefit from currently available preventive and therapeutic interventions for stroke in the general population. In this review, we explore the complexities and challenges of these interventions in the population with renal disease.

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Section: Acute Stroke Treatments In Ckd Thrombolysismentioning

confidence: 99%

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Kelly

Rothwell

2020

Kidney International

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“…Management of stroke in patients with CKD is complicated due to increased risk and side effects of the therapeutic interventions. Jung et al reviewed the data on the use of tissue plasminogen activator in 7168 patients with acute stroke, 28% of whom had CKD. Patients with CKD had an increased risk of intracerebral hemorrhage and were more likely to have a poorer outcome at 3 months.…”

Section: Disorders Of the Central Nervous System In Ckdmentioning

confidence: 99%

The nature, consequences, and management of neurological disorders in chronic kidney disease

Jabbari

Vaziri

2017

Hemodialysis International

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Perhaps no other organ in the body is affected as often and in as many ways as the brain is in patients with chronic kidney disease (CKD). Several factors contribute to the neurological disorders in CKD including accumulation of uremic toxins, metabolic and hemodynamic disorders, oxidative stress, inflammation, and impaired blood brain barrier among others. The neurological disorders in CKD involve both peripheral and central nervous system. The peripheral neurological symptoms of CKD are due to somatic and cranial peripheral neuropathies as well as a myopathy. The central neurological symptoms of CKD are due to the cortical predominantly cortical, or subcortical lesions. Cognitive decline, encephalopathy, cortical myoclonus, asterixis and epileptic seizures are distinct features of the cortical disorders of CKD. Diffuse white matter disease due to ischemia and hypoxia may be an important cause of subcortical encephalopathy. A special and more benign form of subcortical disorder caused by brain edema in CKD is termed posterior reversible encephalopathy. Subcortical pathology especially when it affects the basal ganglia causes a number of movement disorders including Parkinsonism, chorea and dystonia. A stimulus-sensitive reflex myoclonus is believed to originate from the medullary structures. Sleep disorder and restless leg syndrome are common in CKD and have both central and peripheral origin. This article provides an overview of the available data on the nature, prevalence, pathophysiology, consequences and treatment of neurological complications of CKD.

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“…Antithrombotic agents in people with ESKD are associated with increased bleeding and cardiovascular mortality, lacking evidence in reducing stroke incidence [3,5]. transformation and mortality [6]. ESKD-specific factors may also increase bleeding risk, such as frequent anticoagulation with heparin (on haemodialysis) and uraemia-induced impaired platelet function.…”

Section: Discussionmentioning

confidence: 99%

Death From Stroke in End-Stage Kidney Disease

Mata

Masson

Salman

et al. 2019

Stroke

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Background and Purpose— People with end-stage kidney disease (ESKD) are at greater risk of stroke. We aimed to compare stroke mortality between the ESKD population and the general population. Methods— We included all patients with incident ESKD in Australia, 1980 to 2013, and New Zealand, 1988 to 2012. The primary cause of death was ascertained using data linkage with national death registers. We produced standardized mortality ratios for stroke deaths, by age, sex, and calendar year. Results— We included 60 823 patients with ESKD, where 941 stroke deaths occurred during 381 874 person-years. Patients with ESKD had >3× the stroke deaths compared with the general population (standardized mortality ratio, 3.4; 95% CI, 3.2–3.6), markedly higher in younger people and women. The greatest excess was in intracerebral hemorrhages (standardized mortality ratio, 5.2; 95% CI, 4.5–5.9). Excess stroke deaths in patients with ESKD decreased over time, although were still double in 2013 (2013 standardized mortality ratio, 2.1; 95% CI, 1.5–2.9). Conclusions— People with ESKD experience much greater stroke mortality with the greatest difference for women and younger people. However, mortality has improved over time.

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Chronic kidney disease and intravenous thrombolysis in acute stroke: A systematic review and meta-analysis

Cited by 39 publications

References 30 publications

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

The nature, consequences, and management of neurological disorders in chronic kidney disease

Death From Stroke in End-Stage Kidney Disease

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