Thrombolysis in Chinese Ischemic Stroke Patients with Renal Dysfunction

Abstract

Background: Current data concerning the relationship between renal function and clinical outcome among stroke patients treated with intravenous thrombolytic therapy are conflicting. Our aim is to analyze whether the clinical outcome of Chinese ischemic stroke patients treated with thrombolytic therapy is affected by the presence of renal dysfunction. Methods: Chinese patients who received intravenous thrombolytic therapy for acute ischemic stroke were recruited. Renal dysfunction was defined as an estimated glomerular filtration rate (eGFR) <90 ml/min/1.73 m 2 . The primary outcome was independent function (modified Rankin Scale, mRS, 0-2) at 3 months, while secondary outcomes included early improvement of the National Institute of Health Stroke Scale (NIHSS) score of ≥ 4 points at 24 h, symptomatic intracerebral hemorrhage (ICH) within 36 h of treatment and 30-day mortality. Results: A total of 199 patients were recruited, of whom 51.3% had renal dysfunction. There were no significant differences in functional independence at 3 months, NIHSS improvement at 24 h postthrombolysis and 30-day mortality between patients with or without renal dysfunction. Multivariate analysis showed that eGFR as a continuous variable was not an independent risk factor for symptomatic ICH. Conclusion: Chinese ischemic stroke patients with renal dysfunction who received thrombolytic therapy had clinical outcomes similar to those without renal dysfunction.

Influence of Renal Function on Treatment Results after Stroke Thrombectomy

“…However, multivariate regression analysis revealed that lower GFR was not an independent factor for poor outcome (mRS 3-6) after thrombectomy in our large consecutive cohort. These findings are in accordance with several previous analyses on the impact of RD in ischemic stroke patients treated with rtPA that did not find an independent association between RD and poor clinical outcome [7,8,9]. Yet, factors that were independently associated with poor outcome in our cohort were higher age, higher morbidity, and stroke-related factors, including higher initial NIHSS values and particularly poor recanalization rates.…”

“…Overall, RD was present in 20.2% of our patients; and similar to other series [3,6,7], we observed that patients with RD were older and more often suffered from hypertension, hypercholesterolemia, previous strokes, coronary heart disease, and atrial fibrillation than patients with normal renal function. Despite higher morbidity, stroke severity did not differ between patients with and without RD in our group of thrombectomy patients, a finding that is inconsistent with the results of previous studies [3,26,27].…”

“…Prevalence rates of renal dysfunction (RD) in patients with ischemic stroke range from 23.9% up to 51.3% [1,2,3,4,5,6,7,8,9], hence, considerably exceeding age-dependent rates in the general population (8-16%) [10,11,12]. Evidence not only suggests that RD is an independent risk factor for cardiovascular events, including stroke and myocardial infarction [13,14,15], but also indicates that RD is associated with worse functional and clinical outcome in ischemic stroke patients [4,16].…”

“…Existing data with regard to the influence of RD on clinical outcome after thrombolysis are inconsistent [3,5,6,7,8,9]. Some smaller studies did not find any relationship between RD and stroke outcome [7,8,9] after rtPA treatment.…”

“…Existing data with regard to the influence of RD on clinical outcome after thrombolysis are inconsistent [3,5,6,7,8,9]. Some smaller studies did not find any relationship between RD and stroke outcome [7,8,9] after rtPA treatment. On the other hand, a large multicenter analysis reported RD to be associated with worse clinical outcome, higher mortality, and higher rates of symptomatic and any intracerebral hemorrhage (ICH) in acute ischemic stroke patients receiving systemic thrombolytic treatment [3].…”