Format

Send to

Choose Destination
Neurology. 2013 Nov 12;81(20):1780-8. doi: 10.1212/01.wnl.0000435550.83200.9e. Epub 2013 Oct 11.

IV thrombolysis and renal function.

Author information

1
From the Departments of Neurology (H.G., D.J.S., N.P., L.H.B., P.A.L., S.T.E.), University Hospital Basel, Switzerland; Academic Medical Center (S.M.Z., Y.B.R., P.J.N.), University of Amsterdam, the Netherlands; University of Heidelberg (P.R.), Germany; Helsinki University Central Hospital (V.A., J.P., E.H., T.T.), Finland; University Lille North de France (D.L., R.B.), UDSL (EA1046), France; Centre Hospitalier Universitaire Vaudois and University of Lausanne (P.M., C.O.), Switzerland; Municipal Hospital Altenburg (J.B.), Germany; University Hospital Bern (M.A., M.R.H., H.S.), Switzerland; AUSL Modena (A.Z., G.B.), Italy; Clinical Center (V.P.), School of Medicine, University of Belgrade, Serbia; University Hospital Brescia (A.P.), Italy; Swiss Tropical and Public Health Institute (C.S.), University of Basel, Switzerland; University Hospital Zurich (H.S.), Switzerland.

Abstract

OBJECTIVE:

To investigate the association of renal impairment on functional outcome and complications in stroke patients treated with IV thrombolysis (IVT).

METHODS:

In this observational study, we compared the estimated glomerular filtration rate (GFR) with poor 3-month outcome (modified Rankin Scale scores 3-6), death, and symptomatic intracranial hemorrhage (sICH) based on the criteria of the European Cooperative Acute Stroke Study II trial. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Patients without IVT treatment served as a comparison group.

RESULTS:

Among 4,780 IVT-treated patients, 1,217 (25.5%) had a low GFR (<60 mL/min/1.73 m(2)). A GFR decrease by 10 mL/min/1.73 m(2) increased the risk of poor outcome (OR [95% CI]): (ORunadjusted 1.20 [1.17-1.24]; ORadjusted 1.05 [1.01-1.09]), death (ORunadjusted 1.33 [1.28-1.38]; ORadjusted 1.18 [1.11-1.249]), and sICH (ORunadjusted 1.15 [1.01-1.22]; ORadjusted 1.11 [1.04-1.20]). Low GFR was independently associated with poor 3-month outcome (ORadjusted 1.32 [1.10-1.58]), death (ORadjusted 1.73 [1.39-2.14]), and sICH (ORadjusted 1.64 [1.21-2.23]) compared with normal GFR (60-120 mL/min/1.73 m(2)). Low GFR (ORadjusted 1.64 [1.21-2.23]) and stroke severity (ORadjusted 1.05 [1.03-1.07]) independently determined sICH. Compared with patients who did not receive IVT, treatment with IVT in patients with low GFR was associated with poor outcome (ORadjusted 1.79 [1.41-2.25]), and with favorable outcome in those with normal GFR (ORadjusted 0.77 [0.63-0.94]).

CONCLUSION:

Renal function significantly modified outcome and complication rates in IVT-treated stroke patients. Lower GFR might be a better risk indicator for sICH than age. A decrease of GFR by 10 mL/min/1.73 m(2) seems to have a similar impact on the risk of death or sICH as a 1-point-higher NIH Stroke Scale score measuring stroke severity.

[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for HighWire Icon for Bern Open Repository and Information System
Loading ...
Support Center