Renal Dysfunction and In‐Hospital Outcomes in Patients With Acute Ischemic Stroke After Intravenous Thrombolytic Therapy

Rao, Zhenzhen; Gu, Hongqiu; Wang, Xian‐Wei; Xie, Xuewei; Yang, Xin; Wang, Chun‐Juan; Wang, Wenjuan; Xian, Ying; Wang, Yilong; Li, Zi‐Xiao; Xiao, Rui‐Ping; Wang, Yongjun

doi:10.1161/jaha.119.012052

Cited by 10 publications

(21 citation statements)

References 29 publications

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“…Thus, increasing renal dysfunction increases ischemic stroke risk. Rao [33]. This suggests that in-hospital mortality increases, especially with eGFR <45 in patients with ischemic stroke and no association with an increase in-hospital symptomatic intracranial hemorrhage and eGFR was seen.…”

Section: Mortality and Outcome Of Stroke In Esrdmentioning

confidence: 96%

“…This suggests that in-hospital mortality increases, especially with eGFR <45 in patients with ischemic stroke and no association with an increase in-hospital symptomatic intracranial hemorrhage and eGFR was seen. Therefore, tPA therapy can be used in CKD patients [33].…”

Section: Mortality and Outcome Of Stroke In Esrdmentioning

confidence: 99%

“…Thus, increasing renal dysfunction increases ischemic stroke risk. Rao et al conducted a cohort study on 18,320 ischemic stroke patients treated with tPA that showed increased odds of in-hospital mortality in patient switch eGFR <45 (6.7% vs. 0.9%, adjusted OR, 3.59; 95% CI: 2.18-5.91), eGFR 45-59 (4.0% vs. 0.9%, adjusted OR, 2.00; 95% CI: 1.18-3.38) and no statistically significant difference for symptomatic intracerebral hemorrhage with eGFR <45 (OR, 0.86; 95% CI: 0.59-1.24) and eGFR 45-59 (OR, 1.08; 95% CI: 0.79-1.48), respectively [ 33 ]. This suggests that in-hospital mortality increases, especially with eGFR <45 in patients with ischemic stroke and no association with an increase in-hospital symptomatic intracranial hemorrhage and eGFR was seen.…”

Section: Reviewmentioning

confidence: 99%

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Current Trends Featuring the Bridge Between Stroke and End-Stage Renal Disease: A Review

Akku¹,

Jayaprakash²,

Ogbue³

et al. 2020

Cureus

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The relationship between end-stage renal disease (ESRD) and cerebral stroke is graded and cumulative, having a significant impact on morbidity and mortality. Ischemic stroke is more prevalent than hemorrhagic stroke and both stroke types have modifiable and non-modifiable risk factors. The presence of risk factors such as hypertension, diabetes, and atrial fibrillation (AF) before stroke occurrence in dialysis patients has a significant impact on the outcomes such as a discharge to rehabilitation, in-hospital mortality with the worst prognosis when compared to the general population. ESRD patients with either peritoneal or hemodialysis (HD) are at increased risk of stroke than the general population, with a high mortality rate at the commencement of dialysis and gradually decreases. Primary and secondary prevention of risk factors plays a significant role in this susceptible population and helps to mitigate better treatment and outcomes. Our review article focuses on the mechanisms, outcomes, treatment, and preventive aspects of stroke in the ESRD population.

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Section: Mortality and Outcome Of Stroke In Esrdmentioning

confidence: 96%

Section: Mortality and Outcome Of Stroke In Esrdmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

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Current Trends Featuring the Bridge Between Stroke and End-Stage Renal Disease: A Review

Akku¹,

Jayaprakash²,

Ogbue³

et al. 2020

Cureus

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“…A decreasing glomerular filtration rate (GFR) affects not only nephron arteries but also cerebral arteries [ 12 ]. CKD increases the risk of worse outcomes, stroke severity, and hemorrhagic transformation among ischemic stroke patients, which has been elucidated in some studies [ 13 – 15 ]. However, there are few studies exploring the relationship between CKD and outcomes of ICH, especially with large sample sizes from Asian populations.…”

Section: Introductionmentioning

confidence: 99%

Effects of estimated glomerular filtration rate on clinical outcomes in patients with intracerebral hemorrhage

Zhou

et al. 2022

BMC Neurol

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Background The influence of chronic kidney disease (CKD) on the severity and prognosis of spontaneous intracerebral hemorrhage (ICH) has been scarcely investigated. We aimed to explore the association of admission estimated glomerular filtration rate (eGFR) levels with hemorrhagic stroke severity and outcomes in ICH patients. Materials and methods The patients enrolled in this study were from the China Stroke Center Alliance study (CSCA). Patients were divided into four groups according to differences in eGFR at admission (≥90; 60–89; 45–59; < 45). Multivariable logistic regression analysis was used to determine the association of the eGFR at admission with hemorrhagic stroke severity, in-hospital complications, discharge disposition, and in-hospital mortality after ICH. Results A total of 85,167 patients with acute ICH were included in the analysis. Among them, 9493 (11.1%) had a baseline eGFR<60 ml/min/1.73 m2. A low eGFR was associated with an increased risk of in-hospital mortality [eGFR 60–89 ml/min/1.73 m2, odds ratio (OR) 1.36 (95% confidence interval (CI) 1.21–1.53); eGFR 45–59, 2.35 (1.97–2.82); eGFR<45, 4.18 (3.7–4.72); P for trend < 0.0001], non-routine discharge [eGFR 60–89, 1.11 (1.03–1.2); eGFR 45–59, 1.16 (1–1.35); eGFR<45, 1.37 (1.23–1.53); P for trend < 0.0001], hemorrhagic stroke severity [eGFR 60–89, 1 (0.95–1.05); eGFR 45–59, 1.39 (1.26–1.53); eGFR<45, 1.81 (1.67–1.96); P for trend < 0.0001], in-hospital complications of pneumonia [eGFR 60–89, 1.1 (1.05–1.14); eGFR 45–59, 1.3 (1.2–1.4); eGFR<45, 1.66 (1.57–1.76); P for trend < 0.0001] and hydrocephalus [eGFR 60–89, 0.99 (0.87–1.12); eGFR 45–59, 1.37 (1.1–1.7); eGFR<45, 1.54 (1.32–1.8); P for trend = 0.0139] after adjusting for confounding factors. With the decline in eGFR, the risk of hematoma evacuation increased in patients with an eGFR 45 to 59 ml/min/1.73 m2 (OR 1.48; 95% CI 1.37–1.61). No significant association between differences in eGFR at baseline and in-hospital complication of recurrent intracerebral hemorrhage was observed. Conclusions Low eGFR at baseline was associated with an increased risk of in-hospital mortality, non-routine discharge, hemorrhagic stroke severity and in-hospital complications such as pneumonia, hydrocephalus and hematoma evacuation in acute ICH patients.

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“…Although some studies have shown that no significant association exists between eGFR and clinical outcomes after reperfusion treatment, many clinicians are still reluctant to perform reperfusion therapy in patients with low eGFR. In fact, some studies have presented concerns related to reperfusion therapy for ischemic stroke in patients with renal dysfunction [11,12].…”

Section: Introductionmentioning

confidence: 99%

Influence of Estimated Glomerular Filtration Rate on Clinical Outcomes in Patients with Acute Ischemic Stroke Not Receiving Reperfusion Therapies

Eun

Park

Cho

et al. 2021

JCM

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Background: We aimed to determine whether estimated glomerular filtration rate (eGFR) is an independent predictor of clinical outcomes in patients with acute ischemic stroke not treated with reperfusion therapy. Methods: A total of 1420 patients with acute ischemic stroke from a hospital-based stroke registry were included in this study. Patients managed with intravenous thrombolysis or endovascular reperfusion therapy were excluded. The included patients were categorized into five groups according to eGFR, as follows: ≥90, 60–89, 45–59, 30–44, and <30 mL/min/1.73 m2. The effects of eGFR on functional outcome at discharge, in-hospital mortality, neurologic deterioration, and hemorrhagic transformation were evaluated using logistic regression analyses. Results: In univariable logistic regression analysis, reduced eGFR was associated with poor functional outcome at discharge (p < 0.001) and in-hospital mortality (p = 0.001), but not with neurologic deterioration and hemorrhagic transformation. However, no significant associations were observed between eGFR and any clinical outcomes in multivariable analysis after adjusting for clinical and laboratory variables. Conclusions: Reduced eGFR was associated with poor functional outcomes at discharge and in-hospital mortality but was not an independent predictor of short-term clinical outcomes in patients with acute ischemic stroke who did not undergo reperfusion therapy.

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Renal Dysfunction and In‐Hospital Outcomes in Patients With Acute Ischemic Stroke After Intravenous Thrombolytic Therapy

Cited by 10 publications

References 29 publications

Current Trends Featuring the Bridge Between Stroke and End-Stage Renal Disease: A Review

Current Trends Featuring the Bridge Between Stroke and End-Stage Renal Disease: A Review

Effects of estimated glomerular filtration rate on clinical outcomes in patients with intracerebral hemorrhage

Influence of Estimated Glomerular Filtration Rate on Clinical Outcomes in Patients with Acute Ischemic Stroke Not Receiving Reperfusion Therapies

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