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IV thrombolysis and renal function.

Henrik Gensicke1, Sanne M Zinkstok, Yvo B Roos

  • 1From the Departments of Neurology (H.G., D.J.S., N.P., L.H.B., P.A.L., S.T.E.), University Hospital Basel, Switzerland; Academic Medical Center (S.M.Z., Y.B.R., P.J.N.), University of Amsterdam, the Netherlands; University of Heidelberg (P.R.), Germany; Helsinki University Central Hospital (V.A., J.P., E.H., T.T.), Finland; University Lille North de France (D.L., R.B.), UDSL (EA1046), France; Centre Hospitalier Universitaire Vaudois and University of Lausanne (P.M., C.O.), Switzerland; Municipal Hospital Altenburg (J.B.), Germany; University Hospital Bern (M.A., M.R.H., H.S.), Switzerland; AUSL Modena (A.Z., G.B.), Italy; Clinical Center (V.P.), School of Medicine, University of Belgrade, Serbia; University Hospital Brescia (A.P.), Italy; Swiss Tropical and Public Health Institute (C.S.), University of Basel, Switzerland; University Hospital Zurich (H.S.), Switzerland.

Neurology
|October 15, 2013
PubMed
Summary
This summary is machine-generated.

Renal impairment in stroke patients receiving intravenous thrombolysis (IVT) is linked to worse outcomes and increased complications. Lower estimated glomerular filtration rate (GFR) independently predicts poor functional outcomes, death, and symptomatic intracranial hemorrhage (sICH).

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Area of Science:

  • Nephrology
  • Neurology
  • Critical Care Medicine

Background:

  • Stroke remains a leading cause of death and disability worldwide.
  • Intravenous thrombolysis (IVT) is a critical treatment for acute ischemic stroke.
  • The impact of renal function on outcomes following IVT is not fully elucidated.

Purpose of the Study:

  • To investigate the association between renal impairment and functional outcomes.
  • To assess the impact of renal impairment on complication rates in stroke patients treated with IVT.
  • To compare the predictive value of reduced estimated glomerular filtration rate (GFR) for adverse events.

Main Methods:

  • Observational study of 4,780 patients treated with IVT.
  • Comparison of estimated glomerular filtration rate (GFR) with 3-month functional outcomes (modified Rankin Scale), death, and symptomatic intracranial hemorrhage (sICH).
  • Calculation of unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs); patients without IVT served as a comparison group.

Main Results:

  • 25.5% of IVT-treated patients had a low GFR (<60 mL/min/1.73 m²).
  • Each 10 mL/min/1.73 m² decrease in GFR was associated with increased risk of poor outcome, death, and sICH.
  • Low GFR was independently associated with poor 3-month outcome, death, and sICH compared to normal GFR.
  • IVT in patients with low GFR was linked to poor outcomes, while it favored favorable outcomes in those with normal GFR.

Conclusions:

  • Renal function significantly modifies outcomes and complication rates in IVT-treated stroke patients.
  • Lower GFR is a strong predictor of adverse events, potentially better than age for sICH risk.
  • A 10 mL/min/1.73 m² GFR decrease has a similar impact on death/sICH risk as a 1-point increase in NIH Stroke Scale score.