Thrombolysis and hyperacute reperfusion therapy for stroke in renal patients.

Thrombolytic therapy using recombinant tissue plasminogen activator (rt-PA) is established as an effective treatment for patients with acute ischemic stroke. No distinction to the presence of chronic kidney disease (CKD) was made in previous clinical trials. In this chapter, three clinical studies that investigated renal dysfunction on the effect of rt-PA were reviewed and a meta-analysis was performed. In total, 344 patients with CKD and 504 patients without were treated within 3 h of symptom onset. Patients with CKD showed decreased odds of being alive and independent compared to patients with normal renal function (OR 0.60, 95% CI 0.45-0.81). Symptomatic intracranial hemorrhage occurred more in patients with CKD than without (OR 3.38, 95% CI 1.60-7.15). Risk of fatal outcome was also significantly higher in patients with CKD (OR 3.15, 95% CI 1.82-5.45).