Acute and Chronic Kidney Dysfunction and Outcome After Stroke Thrombectomy

Abstract

Data on the impact of kidney dysfunction on outcome in patients with stroke due to large vessel occlusion are scarce. The few available studies are limited by only considering single kidney parameters measured at one time point. We thus investigated the influence of both chronic kidney disease (CKD) and acute kidney injury (AKI) on outcome after mechanical thrombectomy. We included consecutive patients with anterior circulation large vessel occlusion stroke receiving mechanical thrombectomy at our center over an 8-year period. We extracted clinical data from a prospective registry and investigated kidney serum parameters at admission, the following day and throughout hospital stay. CKD and AKI were defined according to established nephrological criteria. Unfavorable outcome was defined as scores of 3–6 on the modified Rankin Scale 3 months post-stroke. Among 465 patients, 31.8% had an impaired estimated glomerular filtration rate (eGFR) at admission (< 60 ml/min/1.73 m2). Impaired admission eGFR was related to unfavorable outcome in univariable analysis (p = 0.003), but not after multivariable adjustment (p = 0.96). Patients frequently met AKI criteria at admission (24.5%), which was associated with unfavorable outcome in a multivariable model (OR 3.03, 95% CI 1.73–5.30, p < 0.001). Moreover, patients who developed AKI during hospital stay also had a worse outcome (p = 0.002 in multivariable analysis). While CKD was not associated with 3-month outcome, we identified AKI either at admission or throughout the hospital stay as an independent predictor of unfavorable prognosis in this study cohort. This finding warrants further investigation of kidney–brain crosstalk in the setting of acute stroke.

Construction of a Glycaemia-Based Signature for Predicting Acute Kidney Injury in Ischaemic Stroke Patients after Endovascular Treatment

“…It is also an independent prognostic factor for long-term (10-year) mortality and new composite cardiovascular events [24]. However, the incidence of AKI in patients receiving EVT differed between studies, ranging from 3.3% to 42.8% [3][4][5]. Some researchers have reported that AKI is uncommon in patients receiving EVT [3], whereas others found it is a common complication after acute stroke [5].…”

“…However, the incidence of AKI in patients receiving EVT differed between studies, ranging from 3.3% to 42.8% [3][4][5]. Some researchers have reported that AKI is uncommon in patients receiving EVT [3], whereas others found it is a common complication after acute stroke [5]. A systematic review showed that the rates of AKI after stroke varied from 0.82% to 26.68%, and the pooled incidence was 9.61% [23].…”

“…Although it has been proven to be beneficial in reducing disability [1], nearly 50% of patients did not obtain favourable outcomes after successful recanalization [2]. The incidence of AKI after ischaemic stroke varies from 3.3% to 42.8% in patients undergoing EVT [3][4][5]. Previous studies have shown that AKI is associated with worse outcomes and increased mortality [3][4][5].…”

“…The incidence of AKI after ischaemic stroke varies from 3.3% to 42.8% in patients undergoing EVT [3][4][5]. Previous studies have shown that AKI is associated with worse outcomes and increased mortality [3][4][5]. Diabetes mellitus (DM) is regarded as a risk factor for poor functional outcomes and AKI after EVT in ischaemic stroke patients [4].…”

A Dynamic Nomogram to Identify Patients at High Risk of Poor Outcome in Stroke Patients with Chronic Kidney Disease

“… 31 A previous study also verified that CKD was not related to 3-month poor outcome for patients treated with MT. 32 …”