Renal Dysfunction and Thrombolytic Therapy in Patients With Acute Ischemic Stroke

Abstract

Renal dysfunction is a prevalent comorbidity in acute ischemic stroke patients requiring thrombolytic therapy. However, the effect of renal dysfunction on the clinical outcome of this population remains controversial.This study aimed to evaluate the safety and effectiveness of thrombolytic therapy in acute stroke patients with renal dysfunction using a meta-analysis.We systematically searched PubMed and EMBASE for studies that evaluated the relationship between renal dysfunction and intravenous tissue plasminogen activator (tPA) in patients with acute ischemic stroke. Poor outcome (modified Rankin Scale ≥2), mortality, and symptomatic intracranial hemorrhage (ICH) and any ICH were analyzed.Fourteen studies were included (N = 53,553 patients). The mean age ranged from 66 to 75 years. The proportion of male participants was 49% to 74%. The proportion of renal dysfunction varied from 21.9% to 83% according to different definitions. Based on 9 studies with a total of 7796 patients, the meta-analysis did not identify a significant difference in the odds of poor outcome (odds ratio [OR] = 1.06; 95% confidence interval [CI]: 0.96–1.16; I2 = 44.5) between patients with renal dysfunction and those without renal dysfunction. Patients with renal dysfunction were more likely to die after intravenous thrombolysis (OR = 1.13; 95% CI: 1.05–1.21; I2 = 70.3). No association was observed between symptomatic ICH (OR = 1.02; 95% CI: 0.94–1.10; I2 = 0) and any ICH (OR = 1.07; 95% CI: 0.96–1.18; I2 = 25.8).Renal dysfunction does not increase the risk of poor outcome and ICH after stroke thrombolysis. Renal dysfunction should not be a contraindication for administration of intravenous thrombolysis to eligible patients.

Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis

“…It is inevitable to encounter this group of patients requiring rt‐PA for emergent management. Thus, pros and cons of rt‐PA should be carefully weighed by the first‐line clinicians . However, it remains undetermined whether or not rt‐PA will pose a threat for stroke patients with prior CKD.…”

“…Thus, pros and cons of rt-PA should be carefully weighed by the first-line clinicians. 25,26 However, it remains undetermined whether or not rt-PA will pose a threat for stroke patients with prior CKD. 27 The degree of stiffness in the artery structure, namely the tunica intima, varies in the stroke patient groups mentioned above.…”

Renal Dysfunction Is an Independent Risk Factor for Poor Outcome in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis: A New Cutoff Value

“…Recently a meta-analysis done by Hao evaluating 7796 stroke patients reported that renal dysfunction did not increase the risk of a poor outcome in patients who received thrombolysis [19]. Nevertheless, in Hao's study, the definition for renal insufficiency was considered as GFR < 60 in 7167 (91.9%) and GFR < 90 in 196 (2.5%) and proteinuria in 432 (5.5%) patients.…”

“…Interestingly, it has been shown that patients with renal dysfunction die from indirect causes rather than stroke. Besides, morbidity and mortality can frequently be attributed to other causes such as cardiac disease and susceptibility to infection [19]. …”

Thrombolysis in Chinese Ischemic Stroke Patients with Renal Dysfunction

“…A recently conducted meta-analysis including 14 studies (n = 53,553 patients) has not revealed any significant difference in the odds of poor outcome or ICH between patients with and without renal dysfunction; while the risk of mortality after thrombolytic therapy was significantly higher in patients with renal dysfunction [21] . However, the majority of patients of these studies were from the Western populations and >50% of the data from the metaanalysis were from a US multicenter cohort study with 44,410 participants.…”