Is renal dysfunction associated with adverse stroke outcome after thrombolytic therapy?

Area of Science:

• Neurology
• Nephrology
• Cardiology

Background:

• Renal dysfunction is common in acute stroke patients receiving thrombolysis.
• Previous studies on renal dysfunction and post-thrombolysis symptomatic intracerebral hemorrhage (SICH) have yielded conflicting results.

Purpose of the Study:

• To compare the safety and effectiveness of thrombolytic therapy in acute stroke patients with and without renal dysfunction.
• To investigate the association between varying stages of renal dysfunction and outcomes after thrombolysis.

Main Methods:

• Prospective data from 657 acute stroke patients receiving thrombolysis (2007-2012) were analyzed.
• Renal dysfunction defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m²; stages 3, 4, and 5 were specified.
• Outcomes including SICH and poor functional outcome (modified Rankin Scale ≥4) at 3 months were compared using multivariable logistic regression.

Main Results:

• 36% of patients had renal dysfunction (212 stage 3, 17 stage 4, 10 stage 5).
• No significant differences in SICH (8% vs. 7%) or poor outcome (41% vs. 39%) were observed between patients with and without renal dysfunction.
• Renal dysfunction was not associated with SICH or poor outcome; pretreatment stroke severity was the only significant predictor.

Conclusions:

• Renal dysfunction does not elevate the risk of SICH or poor outcomes at 3 months post-stroke thrombolysis.
• Further research is needed to directly compare thrombolytic therapy versus no therapy in stroke patients with renal dysfunction.