Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis

• Published in: Nephrology (Carlton, Vic.) Vic.), 2019-09, Vol.24 (9), p.896-903
• Main Authors: Chang, Teng‐Hsiang, Chiu, Ping‐Fang, Tsai, Chun‐Chieh, Chang, Chin‐Hua, Wu, Chia‐Lin, Kor, Chew‐Teng, Li, Jhao‐Rong, Kuo, Cheng‐Ling, Huang, Ching‐Shan, Chu, Cheng‐Chung, Lin, Chih‐Ming, Chang, Chia‐Chu
• Format: Article
• Language: English
• Subjects: acute ischemic stroke; Administration, Intravenous; Aged; Aged, 80 and over; Brain - drug effects; Brain - physiopathology; Brain Ischemia - diagnosis; Brain Ischemia - drug therapy; Brain Ischemia - physiopathology; chronic kidney disease; Confidence intervals; Epidermal growth factor receptors; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Glomerular filtration rate; Glomerular Filtration Rate - drug effects; Hemorrhage; Humans; Intravenous administration; Ischemia; Kidney - drug effects; Kidney - physiopathology; Kidney diseases; Male; Middle Aged; Patients; recombinant tissue plasminogen activator; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - physiopathology; renal outcomes; Risk Assessment; Risk Factors; Stroke; Stroke - diagnosis; Stroke - drug therapy; Stroke - physiopathology; t-Plasminogen activator; Thrombolysis; thrombolytic therapy; Thrombolytic Therapy - adverse effects; Time Factors; Time-to-Treatment; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - adverse effects; Treatment Outcome
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.13516

ABSTRACT Aim Recombinant tissue plasminogen activator (rt‐PA) administration is the most prevalent treatment for acute ischemic within golden time. However, the effects of rt‐PA on the kidney function in such patients remain unknown. This study determined long‐term renal outcomes in patients with acute ischemic stroke receiving systemic rt‐PA. Methods We enroled patients who were hospitalized for acute ischemic stroke from January 2001 to January 2017. We applied 1:2 propensity score matching to eliminate various confounding variables. We defined surrogate renal outcomes as declining of estimated glomerular filtration rate (eGFR) greater than 30% and 50%, and chronic kidney disease (CKD) with eGFR less than 60 mL/min. We then compared the 1‐year eGFR with paired t‐test in patients treated with or without rt‐PA. Results Overall, 343 of 1739 patients received rt‐PA within golden time. After 1:2 propensity score matching, their baseline characteristics were grouped as treated with rt‐PA (n = 235) or not (n = 394). rt‐PA‐treated patients exhibited slower renal progression, including the risk of eGFR declining greater than 30% (hazard ratio (HR), 0.72; P = 0.03), risk of declining eGFR greater than 50% (HR, 0.63; P = 0.046) and risk of CKD (HR, 0.61; P = 0.005). After 1‐year cohort, the rt‐PA group exhibited an improved renal outcome by the paired t‐test (propensity match: ΔGFR = 9.1 (95% confidence interval: 6.3, 11.8), P