This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Objective To determine the association of chronic kidney disease (CKD) with the safety and efficacy of IV thrombolysis (IVT) among patients with acute ischemic stroke (AIS).
Methods A systematic review and pairwise meta-analysis of studies involving patients with CKD undergoing IVT for AIS were conducted to evaluate the following outcomes: symptomatic intracranial hemorrhage (sICH), asymptomatic and any intracranial hemorrhage (ICH), in-hospital and 3-month mortality, 3-month favorable functional outcome (FFO; modified Rankin Scale [mRS] score 0–1), and 3-month functional independence (FI, mRS score 0–2). CKD was defined with estimated glomerular filtration rate (eGFR) ranging from mild (eGFR 60–89 mL/min) to moderate (eGFR 30–59 mL/min) to severe (eGFR 15–29 mL/min).
Results We identified 20 studies comprising 60,486 patients with AIS treated with IVT. In unadjusted analyses, CKD was associated with sICH according to the National Institute of Neurological Disorders and Stroke (NINDS) (7 studies; odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19–1.67) and European Cooperative Acute Stroke Study (ECASS) II (9 studies; OR 1.37, 95% CI 1.01–1.85) definitions, any ICH (8 studies; OR 1.42, 95% CI 1.18–1.70), 3-month mortality (9 studies; OR 2.20, 95% CI 1.72–2.81), 3-month FFO (8 studies; OR 0.58, 95% CI 0.47–0.72), and 3-month FI (8 studies; OR 0.57, 95% CI 0.46–0.71). In adjusted analyses, CKD was associated with sICH according to NINDS (4 studies; ORadj 1.34, 95% CI 1.01–1.79) and ECASS II (3 studies; ORadj 2.08, 95% CI 1.27–3.43) definitions, any ICH (6 studies; ORadj 1.41, 95% CI 1.01–1.97), in-hospital mortality (2 studies; ORadj 1.19, 95% CI 1.09–1.30), and 3-month FFO (6 studies; ORadj 0.80, 95% CI 0.70–0.92).
Conclusions After adjustment for confounders in this pairwise meta-analysis, moderate to severe CKD is associated with increased risks of ICH and worse functional outcomes among patients with AIS treated with IVT.
Glossary
- AIS=
- acute ischemic stroke;
- aPTT=
- activated partial thromboplastin time;
- CI=
- confidence interval;
- CKD=
- chronic kidney disease;
- ECASS=
- European Cooperative Acute Stroke Study;
- eGFR=
- estimated glomerular filtration rate;
- ESRD=
- end-stage renal disease;
- FFO=
- favorable functional outcome;
- FI=
- functional independency;
- ICH=
- intracranial hemorrhage;
- IST-3=
- Third International Stroke Trial;
- IVT=
- IV thrombolysis;
- mRS=
- modified Rankin Scale;
- OR=
- odds ratio;
- ORadj=
- adjusted OR;
- RCT=
- randomized controlled clinical trial;
- sICH=
- symptomatic intracranial hemorrhage;
- SITS-MOST=
- Safe Implementation of Thrombolysis in Stroke–Monitoring Study
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received September 7, 2019.
- Accepted in final form December 12, 2019.
- © 2020 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Topics Discussed
Alert Me
Recommended articles
Safety and efficacy of dual antiplatelet pretreatment in patients with ischemic stroke treated with IV thrombolysis
Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke
Clinical and Neuroimaging Outcomes of Direct Thrombectomy vs Bridging Therapy in Large Vessel Occlusion
Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion