Loading…
Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis
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 ac...
Saved in:
| Published in: | Nephrology (Carlton, Vic.) Vic.), 2019-09, Vol.24 (9), p.896-903 |
|---|---|
| Main Authors: | , , , , , , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c3536-6df8db8c3983bd9b0fa97585e8948a2a3ea10dfa66ac1c40f9ea13aca855b4453 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c3536-6df8db8c3983bd9b0fa97585e8948a2a3ea10dfa66ac1c40f9ea13aca855b4453 |
| container_end_page | 903 |
| container_issue | 9 |
| container_start_page | 896 |
| container_title | Nephrology (Carlton, Vic.) |
| container_volume | 24 |
| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1111/nep.13516 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2122578877</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2122578877</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3536-6df8db8c3983bd9b0fa97585e8948a2a3ea10dfa66ac1c40f9ea13aca855b4453</originalsourceid><addsrcrecordid>eNp1kUFu1jAQhSMEoqWw4ALIEhtYpLXjOHHYoV8tIFXAAtbRxBmrbhM72E4hu-56AG7ISRj4CwskvLDHM5-e7PeK4qngx4LWicflWEglmnvFoahrXoq2a-9TLSteKqn0QfEopUvORVs14mFxILmUNW2Hxe0ZXIc1wjAhi-hhYmHNJsyYGNiMkTmfI1yjD2ti-SKGeQjTlp2hC0ZYNmZDZGDWjMwlc4EzjVKO4Qpfsd3kvDOk6eZloiK74Fmw7MqNHrcfN9-HCM4z-ObS4-KBhSnhk7vzqPh8dvpp97Y8__Dm3e71eWmkkk3ZjFaPgzay03IYu4Fb6FqlFequ1lCBRBB8tNA0YISpue2oIcGAVmqoayWPihd73SWGLyum3M_0bJwm8Ehf7CtRVarVum0Jff4PeklOkUVEVWSk1K0QRL3cUyaGlCLafoluhrj1gve_0ukpnf53OsQ-u1NchxnHv-SfOAg42QNf3YTb_5X696cf95I_AdDBnQU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2272638711</pqid></control><display><type>article</type><title>Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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 < 0.001 in rt‐PA group; ΔGFR = −1.1 (95% confidence interval: −2.9, 0.7), P = 0.23 in non‐rt‐PA group). In patients with eGFR less than 45 mL/min (n = 34), intracerebral haemorrhage was not reported.
Conclusion
Patients receiving rt‐PA for acute ischemic stroke exhibit favourable renal outcomes, and no increased incidence of intracerebral haemorrhage occurs in rt‐PA patients with advanced CKD.
SUMMARY AT A GLANCE
The authors hypothesize that neuro‐hormonal responses to ischaemic brain injury in stroke may affect kidney function. They compared changes in kidney function over time in patients treated with thrombolysis to those who were not. In these observational data, kidney function deteriorated less in patients who received thrombolysis for stroke.</description><identifier>ISSN: 1320-5358</identifier><identifier>EISSN: 1440-1797</identifier><identifier>DOI: 10.1111/nep.13516</identifier><identifier>PMID: 30334303</identifier><language>eng</language><publisher>Melbourne: John Wiley & Sons Australia, Ltd</publisher><subject>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</subject><ispartof>Nephrology (Carlton, Vic.), 2019-09, Vol.24 (9), p.896-903</ispartof><rights>2018 Asian Pacific Society of Nephrology</rights><rights>2018 Asian Pacific Society of Nephrology.</rights><rights>2019 Asian Pacific Society of Nephrology</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3536-6df8db8c3983bd9b0fa97585e8948a2a3ea10dfa66ac1c40f9ea13aca855b4453</citedby><cites>FETCH-LOGICAL-c3536-6df8db8c3983bd9b0fa97585e8948a2a3ea10dfa66ac1c40f9ea13aca855b4453</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30334303$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chang, Teng‐Hsiang</creatorcontrib><creatorcontrib>Chiu, Ping‐Fang</creatorcontrib><creatorcontrib>Tsai, Chun‐Chieh</creatorcontrib><creatorcontrib>Chang, Chin‐Hua</creatorcontrib><creatorcontrib>Wu, Chia‐Lin</creatorcontrib><creatorcontrib>Kor, Chew‐Teng</creatorcontrib><creatorcontrib>Li, Jhao‐Rong</creatorcontrib><creatorcontrib>Kuo, Cheng‐Ling</creatorcontrib><creatorcontrib>Huang, Ching‐Shan</creatorcontrib><creatorcontrib>Chu, Cheng‐Chung</creatorcontrib><creatorcontrib>Lin, Chih‐Ming</creatorcontrib><creatorcontrib>Chang, Chia‐Chu</creatorcontrib><title>Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis</title><title>Nephrology (Carlton, Vic.)</title><addtitle>Nephrology (Carlton)</addtitle><description>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 < 0.001 in rt‐PA group; ΔGFR = −1.1 (95% confidence interval: −2.9, 0.7), P = 0.23 in non‐rt‐PA group). In patients with eGFR less than 45 mL/min (n = 34), intracerebral haemorrhage was not reported.
Conclusion
Patients receiving rt‐PA for acute ischemic stroke exhibit favourable renal outcomes, and no increased incidence of intracerebral haemorrhage occurs in rt‐PA patients with advanced CKD.
SUMMARY AT A GLANCE
The authors hypothesize that neuro‐hormonal responses to ischaemic brain injury in stroke may affect kidney function. They compared changes in kidney function over time in patients treated with thrombolysis to those who were not. In these observational data, kidney function deteriorated less in patients who received thrombolysis for stroke.</description><subject>acute ischemic stroke</subject><subject>Administration, Intravenous</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Brain - drug effects</subject><subject>Brain - physiopathology</subject><subject>Brain Ischemia - diagnosis</subject><subject>Brain Ischemia - drug therapy</subject><subject>Brain Ischemia - physiopathology</subject><subject>chronic kidney disease</subject><subject>Confidence intervals</subject><subject>Epidermal growth factor receptors</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Fibrinolytic Agents - adverse effects</subject><subject>Glomerular filtration rate</subject><subject>Glomerular Filtration Rate - drug effects</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Intravenous administration</subject><subject>Ischemia</subject><subject>Kidney - drug effects</subject><subject>Kidney - physiopathology</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>recombinant tissue plasminogen activator</subject><subject>Renal Insufficiency, Chronic - diagnosis</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>renal outcomes</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Stroke</subject><subject>Stroke - diagnosis</subject><subject>Stroke - drug therapy</subject><subject>Stroke - physiopathology</subject><subject>t-Plasminogen activator</subject><subject>Thrombolysis</subject><subject>thrombolytic therapy</subject><subject>Thrombolytic Therapy - adverse effects</subject><subject>Time Factors</subject><subject>Time-to-Treatment</subject><subject>Tissue Plasminogen Activator - administration & dosage</subject><subject>Tissue Plasminogen Activator - adverse effects</subject><subject>Treatment Outcome</subject><issn>1320-5358</issn><issn>1440-1797</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kUFu1jAQhSMEoqWw4ALIEhtYpLXjOHHYoV8tIFXAAtbRxBmrbhM72E4hu-56AG7ISRj4CwskvLDHM5-e7PeK4qngx4LWicflWEglmnvFoahrXoq2a-9TLSteKqn0QfEopUvORVs14mFxILmUNW2Hxe0ZXIc1wjAhi-hhYmHNJsyYGNiMkTmfI1yjD2ti-SKGeQjTlp2hC0ZYNmZDZGDWjMwlc4EzjVKO4Qpfsd3kvDOk6eZloiK74Fmw7MqNHrcfN9-HCM4z-ObS4-KBhSnhk7vzqPh8dvpp97Y8__Dm3e71eWmkkk3ZjFaPgzay03IYu4Fb6FqlFequ1lCBRBB8tNA0YISpue2oIcGAVmqoayWPihd73SWGLyum3M_0bJwm8Ehf7CtRVarVum0Jff4PeklOkUVEVWSk1K0QRL3cUyaGlCLafoluhrj1gve_0ukpnf53OsQ-u1NchxnHv-SfOAg42QNf3YTb_5X696cf95I_AdDBnQU</recordid><startdate>201909</startdate><enddate>201909</enddate><creator>Chang, Teng‐Hsiang</creator><creator>Chiu, Ping‐Fang</creator><creator>Tsai, Chun‐Chieh</creator><creator>Chang, Chin‐Hua</creator><creator>Wu, Chia‐Lin</creator><creator>Kor, Chew‐Teng</creator><creator>Li, Jhao‐Rong</creator><creator>Kuo, Cheng‐Ling</creator><creator>Huang, Ching‐Shan</creator><creator>Chu, Cheng‐Chung</creator><creator>Lin, Chih‐Ming</creator><creator>Chang, Chia‐Chu</creator><general>John Wiley & Sons Australia, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7X8</scope></search><sort><creationdate>201909</creationdate><title>Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3536-6df8db8c3983bd9b0fa97585e8948a2a3ea10dfa66ac1c40f9ea13aca855b4453</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>acute ischemic stroke</topic><topic>Administration, Intravenous</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Brain - drug effects</topic><topic>Brain - physiopathology</topic><topic>Brain Ischemia - diagnosis</topic><topic>Brain Ischemia - drug therapy</topic><topic>Brain Ischemia - physiopathology</topic><topic>chronic kidney disease</topic><topic>Confidence intervals</topic><topic>Epidermal growth factor receptors</topic><topic>Female</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Fibrinolytic Agents - adverse effects</topic><topic>Glomerular filtration rate</topic><topic>Glomerular Filtration Rate - drug effects</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Intravenous administration</topic><topic>Ischemia</topic><topic>Kidney - drug effects</topic><topic>Kidney - physiopathology</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>recombinant tissue plasminogen activator</topic><topic>Renal Insufficiency, Chronic - diagnosis</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><topic>renal outcomes</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Stroke</topic><topic>Stroke - diagnosis</topic><topic>Stroke - drug therapy</topic><topic>Stroke - physiopathology</topic><topic>t-Plasminogen activator</topic><topic>Thrombolysis</topic><topic>thrombolytic therapy</topic><topic>Thrombolytic Therapy - adverse effects</topic><topic>Time Factors</topic><topic>Time-to-Treatment</topic><topic>Tissue Plasminogen Activator - administration & dosage</topic><topic>Tissue Plasminogen Activator - adverse effects</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chang, Teng‐Hsiang</creatorcontrib><creatorcontrib>Chiu, Ping‐Fang</creatorcontrib><creatorcontrib>Tsai, Chun‐Chieh</creatorcontrib><creatorcontrib>Chang, Chin‐Hua</creatorcontrib><creatorcontrib>Wu, Chia‐Lin</creatorcontrib><creatorcontrib>Kor, Chew‐Teng</creatorcontrib><creatorcontrib>Li, Jhao‐Rong</creatorcontrib><creatorcontrib>Kuo, Cheng‐Ling</creatorcontrib><creatorcontrib>Huang, Ching‐Shan</creatorcontrib><creatorcontrib>Chu, Cheng‐Chung</creatorcontrib><creatorcontrib>Lin, Chih‐Ming</creatorcontrib><creatorcontrib>Chang, Chia‐Chu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Nephrology (Carlton, Vic.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chang, Teng‐Hsiang</au><au>Chiu, Ping‐Fang</au><au>Tsai, Chun‐Chieh</au><au>Chang, Chin‐Hua</au><au>Wu, Chia‐Lin</au><au>Kor, Chew‐Teng</au><au>Li, Jhao‐Rong</au><au>Kuo, Cheng‐Ling</au><au>Huang, Ching‐Shan</au><au>Chu, Cheng‐Chung</au><au>Lin, Chih‐Ming</au><au>Chang, Chia‐Chu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis</atitle><jtitle>Nephrology (Carlton, Vic.)</jtitle><addtitle>Nephrology (Carlton)</addtitle><date>2019-09</date><risdate>2019</risdate><volume>24</volume><issue>9</issue><spage>896</spage><epage>903</epage><pages>896-903</pages><issn>1320-5358</issn><eissn>1440-1797</eissn><abstract>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 < 0.001 in rt‐PA group; ΔGFR = −1.1 (95% confidence interval: −2.9, 0.7), P = 0.23 in non‐rt‐PA group). In patients with eGFR less than 45 mL/min (n = 34), intracerebral haemorrhage was not reported.
Conclusion
Patients receiving rt‐PA for acute ischemic stroke exhibit favourable renal outcomes, and no increased incidence of intracerebral haemorrhage occurs in rt‐PA patients with advanced CKD.
SUMMARY AT A GLANCE
The authors hypothesize that neuro‐hormonal responses to ischaemic brain injury in stroke may affect kidney function. They compared changes in kidney function over time in patients treated with thrombolysis to those who were not. In these observational data, kidney function deteriorated less in patients who received thrombolysis for stroke.</abstract><cop>Melbourne</cop><pub>John Wiley & Sons Australia, Ltd</pub><pmid>30334303</pmid><doi>10.1111/nep.13516</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1320-5358 |
| ispartof | Nephrology (Carlton, Vic.), 2019-09, Vol.24 (9), p.896-903 |
| issn | 1320-5358 1440-1797 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2122578877 |
| source | Wiley-Blackwell Read & Publish Collection |
| 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 |
| title | Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-18T22%3A27%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Favourable%20renal%20outcomes%20after%20intravenous%20thrombolytic%20therapy%20for%20acute%20ischemic%20stroke:%20Clinical%20implication%20of%20kidney%E2%80%93brain%20axis&rft.jtitle=Nephrology%20(Carlton,%20Vic.)&rft.au=Chang,%20Teng%E2%80%90Hsiang&rft.date=2019-09&rft.volume=24&rft.issue=9&rft.spage=896&rft.epage=903&rft.pages=896-903&rft.issn=1320-5358&rft.eissn=1440-1797&rft_id=info:doi/10.1111/nep.13516&rft_dat=%3Cproquest_cross%3E2122578877%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c3536-6df8db8c3983bd9b0fa97585e8948a2a3ea10dfa66ac1c40f9ea13aca855b4453%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2272638711&rft_id=info:pmid/30334303&rfr_iscdi=true |