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Chronic kidney disease and intravenous thrombolysis in acute stroke: A systematic review and meta-analysis

Jin-Man Jung1, Hyun Jung Kim2, Hyeongsik Ahn2

  • 1Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.

Journal of the Neurological Sciences
|October 6, 2015
PubMed

Insights

Patients with chronic kidney disease (CKD) face increased risks of symptomatic hemorrhage and mortality after receiving intravenous thrombolytics for stroke. This meta-analysis highlights the significant impact of CKD on stroke treatment outcomes.

Area of Science:

  • Nephrology
  • Neurology
  • Cardiovascular Medicine

Background:

  • The relationship between chronic kidney disease (CKD) and bleeding complications or outcomes in patients receiving intravenous thrombolytics remains debated.
  • Acute stroke treatment involves balancing reperfusion benefits against bleeding risks.

Purpose of the Study:

  • To investigate the association between CKD and symptomatic intracerebral hemorrhage (ICH) or clinical outcomes in acute stroke patients treated with IV tissue plasminogen activator (tPA).

Main Methods:

  • A systematic literature search identified eligible observational studies with adjusted analyses.
  • Study quality was assessed, and a meta-analysis was performed.
  • Primary outcome: symptomatic ICH. Secondary outcomes: 3-month functional status, 3-month mortality, and any ICH.

Main Results:

  • Seven studies comprising 7168 patients were analyzed; 27.9% had CKD.
  • CKD patients showed a higher risk of symptomatic ICH (OR 1.56) and mortality (OR 1.70).
  • An increased risk of poor 3-month functional outcome was observed in CKD patients; no significant association with any ICH was found.

Conclusions:

  • Chronic kidney disease is associated with significantly higher risks of symptomatic hemorrhagic complications and adverse clinical outcomes after IV tPA administration in acute stroke.
  • These findings underscore the importance of considering renal function in stroke management and risk stratification.
Abstract

Keywords:
Chronic kidney diseaseMeta-analysisOutcomeStrokeSystematic reviewTissue-type plasminogen activator

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