Intravenous rt-PA in patients with ischaemic stroke and renal dysfunction.

Area of Science:

• Neurology
• Nephrology
• Cardiology

Background:

• Renal dysfunction (RD) is a known risk factor for ischemic stroke (IS).
• The influence of RD on the efficacy and safety of intravenous thrombolysis (iv-thrombolysis) in Caucasian populations requires further elucidation.

Purpose of the Study:

• To investigate the association between renal dysfunction and outcomes in Caucasian patients receiving iv-thrombolysis for IS.
• To determine if RD impacts the safety and efficacy of iv-thrombolysis treatment.

Main Methods:

• An observational, multicenter study involving 404 Caucasian patients with IS treated with iv-thrombolysis.
• Renal dysfunction was defined as an estimated glomerular filtration rate ≤ 60 ml/min/1.73 m².
• Outcomes were assessed using the modified Rankin Scale at 3 months post-stroke, with analyses including mortality and hemorrhagic transformation.

Main Results:

• While patients with RD had a higher unadjusted mortality rate (29.9% vs. 14.3%), multivariate analysis revealed no significant impact of RD on unfavorable outcomes (OR 0.98), mortality (OR 0.92), or hemorrhagic transformation (OR 1.03).
• Baseline NIHSS scores were similar between groups.
• Rates of hemorrhagic transformation did not differ between patients with and without RD.

Conclusions:

• Renal dysfunction does not appear to influence the safety or efficacy of iv-thrombolysis in Caucasian patients with ischemic stroke.
• These findings suggest that RD should not preclude the use of iv-thrombolysis in eligible IS patients.