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Intravenous thrombolysis in patients with chronic kidney disease: A systematic review and meta-analysis

Konark Malhotra1, Aristeidis H Katsanos2, Nitin Goyal2

  • 1From the Department of Neurology (K.M., A.T.), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (A.H.K., A.W.A., A.V.A.), University of Ioannina School of Medicine, Greece; Department of Neurology (N.G., G.T.), University of Tennessee Health Science Center, Memphis; Department of Neurology and Stroke Center (H.G., G.M.D.M.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology (P.D.M.), School of Medicine, University of Crete, Greece; Department of Cardiology (E.B.), Oslo University Hospital, Norway; and Second Department of Neurology (G.T.), National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece. konark.malhotra@yahoo.com.

Neurology
|June 20, 2020
PubMed

Insights

Chronic kidney disease (CKD) increases risks of intracranial hemorrhage (ICH) and adverse outcomes in acute ischemic stroke (AIS) patients receiving IV thrombolysis (IVT). Moderate to severe CKD is linked to higher ICH rates and poorer functional recovery post-IVT.

Area of Science:

  • Nephrology
  • Neurology
  • Cardiovascular Medicine

Background:

  • Chronic kidney disease (CKD) affects stroke outcomes.
  • Intravenous thrombolysis (IVT) is a critical treatment for acute ischemic stroke (AIS).
  • The impact of CKD on IVT safety and efficacy in AIS patients requires clarification.

Purpose of the Study:

  • To determine the association between CKD and the safety and efficacy of IVT in AIS patients.
  • To evaluate risks of intracranial hemorrhage (ICH) and mortality.
  • To assess functional outcomes following IVT in AIS patients with CKD.

Main Methods:

  • Systematic review and pairwise meta-analysis of 20 studies.
  • Included 60,486 patients with AIS treated with IVT.
  • Defined CKD by estimated glomerular filtration rate (eGFR) and analyzed outcomes like symptomatic ICH (sICH), any ICH, mortality, and functional outcomes (FFO, FI).

Main Results:

  • CKD was associated with increased risks of sICH and any ICH in AIS patients treated with IVT.
  • Adjusted analyses showed CKD linked to higher rates of sICH, any ICH, in-hospital mortality, and worse 3-month functional outcomes.
  • CKD was associated with reduced 3-month favorable functional outcome (FFO) and functional independence (FI).

Conclusions:

  • Moderate to severe CKD is associated with increased risks of intracranial hemorrhage (ICH) after IVT for AIS.
  • CKD is linked to worse functional outcomes in AIS patients treated with IVT.
  • These findings highlight the importance of considering CKD when managing AIS patients undergoing IVT.
Abstract

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