Renal Dysfunction Associated with Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis

Renal dysfunction (RD) is prevalent in patients with acute ischemic stroke requiring intravenous thrombolysis. The relationship between renal function and thrombolysis related intracranial hemorrhagic (ICH) complications is contradictory according to previous studies. The current study is to clarify whether RD could increase the risk of symptomatic intracranial hemorrhage (SICH) after recombinant tissue plasminogen activator (IV rtPA) in acute ischemic stroke patients.

In this observational study, acute ischemic stroke patients who received IV rtPA within 4.5 hours of symptom onset were retrospectively analyzed. Creatinine levels on admission served to calculate glomerular filtration rate (GFR) to estimate RD. SICH was defined with National Institute of Neurological Disorder and Stroke (NINDS, SICH_NINDS) or European Cooperative Acute Stroke Study II (ECASS II, SICH_ECASSII) criteria. Association of RD with SICH was assessed using continuous GFR or binary GFR (RD defined as GFR < 90 ml/minute/1.73 m²).

Of 312 patients included, the incidence of SICH_NINDS was 7.69%, of SICH_ECASSII was 5.45%. Patients with RD had higher prevalence of SICH_NINDS (12.80% versus 2.03%, P < .001) and SICH_{ECASS II} (9.15% versus 1.35%, P = .002)_. GFR as a continuous variable was associated with SICH_NINDS (OR_adjust = .97, P = .003), but not with SICH_{ECASS II}. GFR less than 90 ml/minute/1.73 m² remained independently associated with SICH_NINDS (OR_adjust = 4.79, P = .016), and SICH_{ECASS II} (OR_adjust = 2.99, P = .032) in multiple logistic regression analysis.

Renal function is independently associated with SICH after IV rtPA thrombolysis. RD is an independent predictor for both SICH_NINDS and SICHE_{CASS II}. RD should be considered when evaluating the risk of intravenous thrombolysis with IV rtPA.