Jin-Man Jung1, Hyun Jung Kim2, Hyeongsik Ahn2, Il Min Ahn3, Youngrok Do4, Jeong-Yoon Choi1, Woo-Keun Seo5, Kyungmi Oh5, Kyung-Hee Cho6, Sungwook Yu7. 1. Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea. 2. Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea. 3. Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea; Department of Literary Arts, Brown University, RI, USA. 4. Department of Neurology, Daegu Catholic Hospital, Dae-Gu Catholic University College of Medicine, Dae-Gu, Republic of Korea. 5. Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea. 6. Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea. 7. Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea. Electronic address: song4yu@korea.ac.kr.
Abstract
BACKGROUND: The association between chronic kidney disease (CKD) and hemorrhagic complications or clinical outcomes in patients treated with intravenous (IV) thrombolytic agents is controversial. METHODS: We searched multiple databases for studies on the association between CKD and symptomatic intracerebral hemorrhage (ICH) and/or clinical outcomes in acute stroke patients treated with IV tissue plasminogen activator (tPA). Observational studies that evaluated the association between CKD and outcomes after adjusting for other confounding factors were eligible. We assessed study quality and performed a meta-analysis. The main outcome was symptomatic ICH. The secondary outcomes were poor functional status at 3 months using the modified Rankin Scale, mortality at 3 months, and any ICH. RESULTS: Seven studies were selected based on our eligibility criteria. Of 7168 patients treated with IV tPA, 2001 (27.9%) had CKD. Patients with CKD had a higher risk of symptomatic ICH and mortality [pooled odds ratio (OR) 1.56, 95% confidence interval (CI) 1.05-2.33 and pooled OR 1.70, 95% CI 1.03-2.81, respectively]. Patients with CKD were likely to have an increased risk of poor outcome at 3 months. There was no significant association between CKD and any ICH. CONCLUSIONS: Chronic kidney disease may significantly affect symptomatic hemorrhagic complications and poor clinical outcomes following administration of IV tPA.
BACKGROUND: The association between chronic kidney disease (CKD) and hemorrhagic complications or clinical outcomes in patients treated with intravenous (IV) thrombolytic agents is controversial. METHODS: We searched multiple databases for studies on the association between CKD and symptomatic intracerebral hemorrhage (ICH) and/or clinical outcomes in acute strokepatients treated with IV tissue plasminogen activator (tPA). Observational studies that evaluated the association between CKD and outcomes after adjusting for other confounding factors were eligible. We assessed study quality and performed a meta-analysis. The main outcome was symptomatic ICH. The secondary outcomes were poor functional status at 3 months using the modified Rankin Scale, mortality at 3 months, and any ICH. RESULTS: Seven studies were selected based on our eligibility criteria. Of 7168 patients treated with IV tPA, 2001 (27.9%) had CKD. Patients with CKD had a higher risk of symptomatic ICH and mortality [pooled odds ratio (OR) 1.56, 95% confidence interval (CI) 1.05-2.33 and pooled OR 1.70, 95% CI 1.03-2.81, respectively]. Patients with CKD were likely to have an increased risk of poor outcome at 3 months. There was no significant association between CKD and any ICH. CONCLUSIONS:Chronic kidney disease may significantly affect symptomatic hemorrhagic complications and poor clinical outcomes following administration of IV tPA.
Authors: Eivind Berge; William Whiteley; Heinrich Audebert; Gian Marco De Marchis; Ana Catarina Fonseca; Chiara Padiglioni; Natalia Pérez de la Ossa; Daniel Strbian; Georgios Tsivgoulis; Guillaume Turc Journal: Eur Stroke J Date: 2021-02-19
Authors: Alireza Shirazian; Andres F Peralta-Cuervo; Maria P Aguilera-Pena; Louis Cannizzaro; Vi Tran; Doan Nguyen; Ifeanyi Iwuchukwu Journal: Neurocrit Care Date: 2021-01-05 Impact factor: 3.210