Chronic Kidney Disease and Outcome Following Endovascular Thrombectomy for Acute Ischemic Stroke

Sutherland, Luke J; Diprose, William K; Wang, Michael T.M.; Barber, P. Alan

doi:10.1016/j.jstrokecerebrovasdis.2020.104665

Cited by 28 publications

(47 citation statements)

References 36 publications

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“…Previous studies investigating kidney function in stroke patients mostly focused on eGFR values at admission alone and limited their analysis to a dichotomization of eGFR into values below or above 60 ml/min/1.73 m 2 [4][5][6][7], obviating a differentiation between pre-existing CKD or AKI. However, these represent two entities, which constitute rather different clinical situations and consequences.…”

Section: Discussionmentioning

confidence: 99%

“…So far, only few studies have investigated whether impaired kidney function at admission would be associated with worse outcome after MT, yielding rather diverging results. While two of them reported worse functional outcome in patients with a baseline estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m 2 , two others found no difference in functional neurological outcome using this eGFR dichotomization [4][5][6][7]. Altogether, these studies are limited by the sole investigation of kidney function at hospital admission and therefore were not able to distinguish between patients with chronic kidney disease (CKD) or acute kidney injury (AKI), the latter representing a more dynamic and potentially reversible condition.…”

Section: Introductionmentioning

confidence: 99%

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Acute and Chronic Kidney Dysfunction and Outcome After Stroke Thrombectomy

Fandler‐Höfler

Odler

Kneihsl

et al. 2021

Transl. Stroke Res.

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Data on the impact of kidney dysfunction on outcome in patients with stroke due to large vessel occlusion are scarce. The few available studies are limited by only considering single kidney parameters measured at one time point. We thus investigated the influence of both chronic kidney disease (CKD) and acute kidney injury (AKI) on outcome after mechanical thrombectomy. We included consecutive patients with anterior circulation large vessel occlusion stroke receiving mechanical thrombectomy at our center over an 8-year period. We extracted clinical data from a prospective registry and investigated kidney serum parameters at admission, the following day and throughout hospital stay. CKD and AKI were defined according to established nephrological criteria. Unfavorable outcome was defined as scores of 3–6 on the modified Rankin Scale 3 months post-stroke. Among 465 patients, 31.8% had an impaired estimated glomerular filtration rate (eGFR) at admission (< 60 ml/min/1.73 m2). Impaired admission eGFR was related to unfavorable outcome in univariable analysis (p = 0.003), but not after multivariable adjustment (p = 0.96). Patients frequently met AKI criteria at admission (24.5%), which was associated with unfavorable outcome in a multivariable model (OR 3.03, 95% CI 1.73–5.30, p < 0.001). Moreover, patients who developed AKI during hospital stay also had a worse outcome (p = 0.002 in multivariable analysis). While CKD was not associated with 3-month outcome, we identified AKI either at admission or throughout the hospital stay as an independent predictor of unfavorable prognosis in this study cohort. This finding warrants further investigation of kidney–brain crosstalk in the setting of acute stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute and Chronic Kidney Dysfunction and Outcome After Stroke Thrombectomy

Fandler‐Höfler

Odler

Kneihsl

et al. 2021

Transl. Stroke Res.

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“…33 While COVID-19 patients may have renal dysfunction, 32 there is conflicting evidence on the effects of renal dysfunction on outcome after thrombectomy for acute ischemic stroke. 34, 35…”

Section: Survey Results and Recommendationsmentioning

confidence: 99%

Stroke Care During the COVID-19 Pandemic: Asian Stroke Advisory Panel Consensus Statement

Pandian

Kusuma

Nilanont

2021

Journal of Stroke Medicine

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The COVID-19 pandemic has impacted the health system worldwide. Stroke is one of the leading causes of death and disability in the world. Asia has a diverse health system and more than two-thirds of strokes occur in this region. The Asian Stroke Advisory Panel (ASAP) conducted a survey among the member countries to explore the impact of COVID-19 on stroke care. The stroke admission numbers have fallen, as have the number of patients who received thrombolysis and mechanical thrombectomy. The stroke unit and rehabilitation beds have been reallocated for COVID-19 care. ASAP recommends emergency department screening of stroke patients for COVID-19 and protected stroke code to be activated for COVID-19 suspect stroke patients. Noncontrast computed tomography (CT), CT angiography, and CT chest are the imaging modalities of choice. All health care professionals involved in triaging, imaging, and stroke care should wear appropriate personal protective equipment. All eligible stroke patients (COVID suspect/positive/non-COVID) should receive intravenous thrombolysis/mechanical thrombectomy. Mobile stroke units and robots can be used wherever available for evaluation and triaging. All stroke patients should receive standard stroke unit care. Limited rehabilitation should be offered to patients and training of caregivers if needed. Telemedicine/telestroke should be used for rehabilitation and follow-up. The ASAP consensus statement can be adapted to suit local and national health care systems.

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“…Acute stroke therapy that includes intravenous thrombolysis and intraarterial interventions like mechanical thrombectomy might be considered as an option for the treatment of stroke in CKD patients (Sutherland et al, 2020). Other stroke prevention therapies like antihypertensive agents, SGLT-2 inhibitors, or antihyperlipidemic drugs like statins might also be considered for use in treatment of stroke in CKD.…”

Section: Interventionsmentioning

confidence: 99%

Cerebro‐renal interaction and stroke

Shah

Jagtap

Sarmah

et al. 2020

Eur J of Neuroscience

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Stroke is an event causing a disturbance in cerebral function leading to death and disability worldwide. Both acute kidney injury and chronic kidney disease (CKD) are associated with an increased risk of stroke and cerebrovascular events. The underlying mechanistic approach between impaired renal function and stroke is limitedly explored and has attracted researchers to learn more for developing therapeutic intervention. Common risk factors such as hypertension, hyperphosphatemia, atrial fibrillation, arteriosclerosis, hyperhomocysteinemia, blood-brain barrier disruption, inflammation, etc. are observed in the general population, but are high in renal failure patients. Also, risk factors like bone mineral metabolism, uremic toxins, and anemia, along with the process of dialysis in CKD patients, eventually increases the risk of stroke. Therefore, early detection of risks associated with stroke in CKD is imperative, which may decrease the mortality associated with it. This review highlights mechanisms by which kidney dysfunction can lead to cerebrovascular events and increase the risk of stroke in renal impairment.

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Chronic Kidney Disease and Outcome Following Endovascular Thrombectomy for Acute Ischemic Stroke

Cited by 28 publications

References 36 publications

Acute and Chronic Kidney Dysfunction and Outcome After Stroke Thrombectomy

Acute and Chronic Kidney Dysfunction and Outcome After Stroke Thrombectomy

Stroke Care During the COVID-19 Pandemic: Asian Stroke Advisory Panel Consensus Statement

Cerebro‐renal interaction and stroke

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