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Intravenous Thrombolysis Improves the Prognosis of Patients with Acute Ischemic Stroke and Chronic Kidney Disease

  • Author Footnotes
    1 These authors contributed equally to the study.
    Yunlong Ding
    Footnotes
    1 These authors contributed equally to the study.
    Affiliations
    Department of Neurology, Jingjiang People's Hospital, Seventh Affiliated Hospital of Yangzhou University, Jiangsu
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  • Author Footnotes
    1 These authors contributed equally to the study.
    Yan Liu
    Footnotes
    1 These authors contributed equally to the study.
    Affiliations
    Department of Neurology, Jingjiang People's Hospital, Seventh Affiliated Hospital of Yangzhou University, Jiangsu
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  • Author Footnotes
    1 These authors contributed equally to the study.
    Qing Huang
    Footnotes
    1 These authors contributed equally to the study.
    Affiliations
    Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing
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  • Author Footnotes
    1 These authors contributed equally to the study.
    Li Ma
    Footnotes
    1 These authors contributed equally to the study.
    Affiliations
    Department of Neurology, Shaoxing Second Hospital, Second Affiliated Hospital of Shaoxing University, Zhejiang, China
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  • Youyong Tian
    Affiliations
    Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing
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  • Junshan Zhou
    Correspondence
    Corresponding Address: Jiali Niu, Department of Clinical Pharmacy, Jingjiang People's Hospital, Seventh Affiliated Hospital of Yangzhou University, 28 Zhongzhou Road, Jingjiang, Jiangsu, 214500 China, or Junshan Zhou, Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
    Affiliations
    Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing
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  • Jiali Niu
    Correspondence
    Corresponding Address: Jiali Niu, Department of Clinical Pharmacy, Jingjiang People's Hospital, Seventh Affiliated Hospital of Yangzhou University, 28 Zhongzhou Road, Jingjiang, Jiangsu, 214500 China, or Junshan Zhou, Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
    Affiliations
    Department of Clinical Pharmacy, Jingjiang People's Hospital, Seventh Affiliated Hospital of Yangzhou University, Jiangsu
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to the study.

      Abstract

      Background

      Chronic kidney disease (CKD) is associated with a higher mortality rate and a poor prognosis among patients with acute ischemic stroke (AIS) who receive intravenous thrombolysis (IVT); however, it is still unclear whether IVT improves the prognosis of patients with AIS and CKD.

      Objective

      We conducted this study to evaluate the impact of IVT in patients with AIS and CKD.

      Methods

      We analyzed patients with AIS and CKD in 3 stroke centers who met the indications for IVT between January 2015 and January 2020. The patients were grouped into an IVT group and a non-IVT group according to whether patients received IVT. After propensity score matching at a 1:1 ratio, symptomatic intracranial hemorrhage (sICH) and the modified Rankin Scale (mRS) score at 3 months were compared to assess the safety and efficacy of IVT in patients with AIS with CKD.

      Results

      A total of 888 patients were enrolled: 763 in the IVT group and 125 in the non-IVT group. After matching, 250 patients were analyzed, and no significant differences were found in sICH between the 2 groups. However, the IVT group had a better 90-day mRS (0–2) score (70.4% vs. 57.6; p = 0.048) than the non-IVT group.

      Conclusions

      IVT improved the 3-month prognosis and did not increase the occurrence of sICH among patients with AIS with CKD.

      Keywords

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      References

        • GBD 2015 Disease and Injury Incidence and Prevalence Collaborators
        Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the global burden of disease study 2015.
        Lancet. 2016; 388: 1545-1602
        • Yang G
        • Wang Y
        • Zeng Y
        • et al.
        Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010.
        Lancet. 2013; 381: 1987-2015
        • Feigin VL
        • Krishnamurthi RV
        • Parmar P
        • et al.
        Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study.
        Neuroepidemiology. 2015; 45: 161-176
        • Ding Y
        • Ji Z
        • Ma L
        • et al.
        Interhospital transfer on intravenous thrombolysis in patients with acute ischemic stroke in three Chinese municipal stroke centers.
        J Thromb Thrombolysis. 2019; 48: 580-586
        • Hacke W
        • Kaste M
        • Bluhmki E
        • et al.
        Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.
        N Engl J Med. 2008; 359: 1317-1329
        • Jauch EC
        • Saver JL
        • Adams HP
        • et al.
        Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2013; 44: 870-947
        • Gensicke H
        • Zinkstok SM
        • Roos YB
        • et al.
        IV thrombolysis and renal function.
        Neurology. 2013; 81: 1780-1788
        • Zhang L
        • Wang F
        • Wang L
        • et al.
        Prevalence of chronic kidney disease in China: a cross-sectional survey.
        Lancet. 2012; 379: 815-822
        • Webster AC
        • Nagler EV
        • Morton RL
        • et al.
        Chronic kidney disease.
        Lancet. 2017; 389: 1238-1252
        • Lee M
        • Saver JL
        • Chang KH
        • et al.
        Low glomerular filtration rate and risk of stroke: meta-analysis.
        BMJ. 2010; 341: c4249
        • Pan Y
        • Jing J
        • Chen W
        • et al.
        Association between impaired renal function and stroke outcome in patients with versus without atrial fibrillation.
        Eur J Neurol. 2018; 25: 1041-1048
        • El Husseini N
        • Fonarow GC
        • Smith EE
        • et al.
        Renal dysfunction is associated with poststroke discharge disposition and in-hospital mortality: findings from get with the guidelines-stroke.
        Stroke. 2017; 48: 327-334
        • Wang IK
        • Liu CH
        • Yen TH
        • et al.
        Renal function is associated with 1-month and 1-year mortality in patients with ischemic stroke.
        Atherosclerosis. 2018; 269: 288-293
        • Cherng YG
        • Lin CS
        • Shih CC
        • et al.
        Stroke risk and outcomes in patients with chronic kidney disease or end-stage renal disease: two nationwide studies.
        PloS One. 2018; 13e0191155
        • Hao Z
        • Yang C
        • Liu M
        • et al.
        Renal dysfunction and thrombolytic therapy in patients with acute ischemic stroke: a systematic review and meta-analysis.
        Medicine (Baltimore). 2014; 93: e286
        • Ovbiagele B
        • Smith EE
        • Schwamm LH
        • et al.
        Chronic kidney disease and bleeding complications after intravenous thrombolytic therapy for acute ischemic stroke.
        Circ Cardiovasc Qual Outcomes. 2014; 7: 929-935
        • Naganuma M
        • Koga M
        • Shiokawa Y
        • et al.
        Reduced estimated glomerular filtration rate is associated with stroke outcome after intravenous rt-PA: the Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement (SAMURAI) rt-PA registry.
        Cerebrovasc Dis. 2011; 31: 123-129
        • Malhotra K
        • Katsanos AH
        • Goyal N
        • et al.
        Intravenous thrombolysis in patients with chronic kidney disease: a systematic review and meta-analysis.
        Neurology. 2020; 95: e121-e130
        • Rao ZZ
        • Gu HQ
        • Wang XW
        • et al.
        Renal dysfunction and in-hospital outcomes in patients with acute ischemic stroke after intravenous thrombolytic therapy.
        J Am Heart Assoc. 2019; 8e012052
        • Carr SJ
        • Wang X
        • Olavarria VV
        • et al.
        Influence of renal impairment on outcome for thrombolysis-treated acute ischemic stroke: enchanted (enhanced control of hypertension and thrombolysis stroke study) post hoc analysis.
        Stroke. 2017; 48: 2605-2609
        • Chinese Society of Neurology
        Chinese Stroke Society. Chinese guidelines for diagnosis and management of acute ischemic stroke 2014.
        Chin J Neurol. 2015; 48: 246-257
        • Chinese Society of Neurology
        Chinese Stroke Society. Chinese guidelines for diagnosis and management of acute ischemic stroke 2018.
        Chin J Neurol. 2018; 51: 666-682
        • Stevens PE
        • Levin A.
        Evaluation and management of chronic kidney disease: synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline.
        Ann Intern Med. 2013; 158: 825-830
        • von Kummer R
        • Broderick JP
        • Campbell BC
        • et al.
        The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy.
        Stroke. 2015; 46: 2981-2986
        • Agrawal V
        • Rai B
        • Fellows J
        • et al.
        In-hospital outcomes with thrombolytic therapy in patients with renal dysfunction presenting with acute ischaemic stroke.
        Nephrol Dial Transplant. 2010; 25: 1150-1157
        • Chao TH
        • Lin TC
        • Shieh Y
        • et al.
        Intracerebral hemorrhage after thrombolytic therapy in acute ischemic stroke patients with renal dysfunction.
        Eur Neurol. 2013; 70: 316-321
        • Ding Y-L
        • Niu J-L
        • Fan J-X
        • Liu Y.
        Repeated mechanical thrombectomy for acute ischemic stroke in a dialysis patient: a case report and literature review.
        Hemodial Int. 2020; 24: E13-E19
        • Yang P
        • Zhang Y
        • Zhang L
        • et al.
        Endovascular thrombectomy with or without intravenous alteplase in acute stroke.
        N Engl J Med. 2020; 382: 1981-1993
        • Pan X
        • Zhou F
        • Shen R
        • et al.
        Influence of renal function on stroke outcome after mechanical thrombectomy: a prospective cohort study.
        BMC Neurol. 2020; 20: 134