Thrombolysis in Acute Ischaemic Stroke Patients with Chronic Kidney Disease

Tiberiu Pana* (Corresponding Author), Jonathan Quinn, Mohamed O. Mohamed, Mamas A Mamas, Phyo Kyaw Myint

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
8 Downloads (Pure)

Abstract

Objective: We aimed to determine whether chronic kidney disease (CKD) is associated with adverse in-hospital outcomes after acute ischaemic stroke (AIS) and whether this association is dependent on thrombolysis administration.


Methods: 885,537 records representative of 4,283,086 AIS admissions were extracted from the US National Inpatient Sample (2005-2015) and categorised into 3 mutually exclusive groups: no CKD, CKD without end-stage renal disease (ESRD) and ESRD. Outcomes (mortality, prolonged hospitalisation >4 days and disability on discharge -derived using discharge destination as a proxy) were compared between groups using multivariable logistic regressions. Separate models containing interaction terms with thrombolysis were also computed.


Results: 
The median age (interquartile range) of the cohort was 73 (61-83) years and 47.32% were men. Compared to the no CKD group, both CKD/no ESRD group (odds ratio (99% confidence interval) = 1.04 (1.0003-1.09), P=0.009) and the ESRD groups (2.06 (1.90-2.25), P<0.001) had significantly increased odds of in-hospital mortality. Patients with CKD/No ESRD (1.03 (1.02-1.06), P<0.001) and ESRD (1.44 (1.37-1.51), P<0.001) were at higher odds of prolonged hospitalisation. Patients with CKD/No ESRD (1.13 (1.10-1.15), P<0.001)and ESRD (1.34 (1.26-1.41), P<0.001) were also at higher odds of moderate-to-severe disability on discharge. Interaction terms between thrombolysis and the CKD/ESRD groups were not statistically significant (P>0.01) for any outcome.


Conclusions: 
Renal dysfunction was independently associated with worse in-hospital outcomes in the acute phase of AIS. These associations were not influenced by the use of thrombolysis as emergency treatment for AIS. CKD/ESRD should not represent sole contraindications to thrombolysis for AIS.
Original languageEnglish
Pages (from-to)669-679
Number of pages11
JournalActa Neurologica Scandinavica
Volume144
Issue number6
Early online date30 Jul 2021
DOIs
Publication statusPublished - 31 Dec 2021

Bibliographical note

ACKNOWLEDGEMENTS
We would like to acknowledge the HCUP Data Partners (https://www.hcup3 us.ahrq.gov/db/hcupdatapartners.jsp).
FUNDING
JQ received the Leslie Wilson Scholarship as part of the Aberdeen Summer Research
Scholarship Programme of the Aberdeen Clinical Academic Training (ACAT) Pathways. The Leslie Wilson Scholarship is funded by the Department of Medicine for the Elderly, NHS Grampian

Keywords

  • Ischaemic Stroke
  • Chronic Kidney Disease
  • Thrombolysis
  • In-hospital Mortality

Fingerprint

Dive into the research topics of 'Thrombolysis in Acute Ischaemic Stroke Patients with Chronic Kidney Disease'. Together they form a unique fingerprint.

Cite this