Carotid intima-media thickness and cerebral white matter lesions are more advanced in acute ischemic stroke patients with renal dysfunction

Ueda, Kae; Watanabe, Yozo; Katsumata, T; Kaneko, Takeshi; Otori, Tatsuo; Utsumi, Kouichi; Iino, Yuichi; Katayama, Yasuo

doi:10.5414/cn106932

Cited by 14 publications

(15 citation statements)

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“…The present study found that old age, presence of hypertension and/or cardio‐embolic stroke, a high NIHSS score and PVH grade at admission, and a high mRS score at discharge were significantly associated with the presence of kidney dysfunction. These findings are consistent with those of previous studies . Kidney dysfunction was diagnosed in 278 patients (65.9%), which is a higher frequency than that in the general population, suggesting that albuminuria and a low eGFR may be risk factors for ischaemic stroke.…”

Section: Discussionsupporting

confidence: 92%

“…A urine sample was collected as needed at admission. 21 Urinary albumin excretion was evaluated using the UACR. The eGFR was determined using the following equation proposed by the Japanese Society of Nephrology: eGFR (mL/min per 1.73 m 2 ) = (194 × serum creatinine level [Cr]) -(1.094 × age) À 0.287 (×0.739 for women).…”

Section: Measurement Of Urinary Albumin Excretion and Egfrmentioning

confidence: 99%

“…Brain MRI was used to detect cerebral white matter lesions in the patients at admission. 21,24 Lesions were investigated in the periventricular white matter and the deep or subcortical white matter. All of the white matter lesions detected on MRI were evaluated, apart from the culprit lesion that was responsible for the acute ischaemic stroke.…”

Section: Cerebral White Matter Lesionsmentioning

confidence: 99%

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High urinary albumin/creatinine ratio at admission predicts poor functional outcome in patients with acute ischaemic stroke

et al. 2017

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Section: Discussionsupporting

confidence: 92%

Section: Measurement Of Urinary Albumin Excretion and Egfrmentioning

confidence: 99%

Section: Cerebral White Matter Lesionsmentioning

confidence: 99%

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High urinary albumin/creatinine ratio at admission predicts poor functional outcome in patients with acute ischaemic stroke

et al. 2017

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“…Besides, renal dysfunction was reported to be independently associated with reduction of efficacy in stroke reperfusion therapy [10]. The underlying mechanism may be the greater cerebrovascular disease burden and poorer collateral circulation [23], altered fibrin clot properties and structures [24,25], and decreased endogenous thrombolysis [26] in patients with renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Is Renal Dysfunction Associated with Adverse Stroke Outcome after Thrombolytic Therapy?

et al. 2013

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Background: Renal dysfunction is a prevalent comorbidity in acute stroke patients requiring thrombolytic therapy. Reports studying the relationship between renal dysfunction and risk of postthrombolytic symptomatic intracerebral hemorrhage (SICH) are contradictory. We aimed to compare the safety and effectiveness of thrombolytic therapy in acute stroke patients with and without renal dysfunction. Methods: Based on the prospective stroke registries of 4 hospitals in Taiwan from 2007-2012, we identified acute stroke patients who received thrombolytic therapy. Clinically significant renal dysfunction was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m². Renal dysfunction was further defined as stage 3 (30 ≤ eGFR < 60 ml/min/ 1.73 m²), stage 4 (15 ≤ eGFR < 30 ml/min/1.73 m²) and stage 5 (<15 ml/min/1.73 m²). The rates of SICH and poor outcome (defined as modified Rankin scale score ≥4) at 3 months after thrombolytic therapy were compared in patients with and without renal dysfunction. SICH was determined according to the definition of the National Institute of Neurological Disorders and Stroke. Multivariable logistic regression was used to determine the effect of renal dysfunction on outcome. Patients with different stages of renal dysfunction were further analyzed to determine the effect of disease severity on outcome. Results: Of the 657 stroke patients with thrombolysis, 239 (36%) had renal dysfunction, including 212 patients in stage 3, 17 patients in stage 4 and 10 patients in stage 5 of renal dysfunction. Patients with renal dysfunction were older and more likely to have hypertension, ischemic heart disease, congestive heart failure and prior antiplatelet use than those without. There were no differences in SICH (8 vs. 7%, p = 0.580) and poor outcome (41 vs. 39%, p = 0.758) between patients with and without renal dysfunction. After multivariable analysis, renal dysfunction was not associated with SICH (odds ratio: 1.03, 95% confidence interval: 0.55-1.92) and poor outcome. Pretreatment stroke severity was the only factor significantly associated with both SICH and poor outcome at 3 months. When stratifying renal dysfunction into stage 3 and stage ≥4, there was no significant increase in SICH as the severity of renal dysfunction increased after multivariable adjustment. Conclusions: Renal dysfunction did not increase the risk of SICH and poor outcome at 3 months after stroke thrombolysis. Further study comparing directly the risk and benefit of thrombolytic therapy versus no therapy in stroke patients with renal dysfunction is warranted.

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“…Studies have shown that patients with end-stage renal disease have more compact, rigid clots with smaller fibrin network pore sizes and greater resistance to fibrinolysis with alteplase in vitro compared to those from people with normal renal function [29,30]. CKD is associated with greater subclinical cerebrovascular disease burden [31], and this may compromise collateral blood flow around infarcts, a factor known to influence recanalization rates [32,33]. It is possible that patients with renal impairment have larger infarct volumes and/or proportionately smaller ischemic penumbrae that are responsive to reperfusion [34].…”

Section: Discussionmentioning

confidence: 99%

Renal Impairment Reduces the Efficacy of Thrombolytic Therapy in Acute Ischemic Stroke

Power¹,

Epstein

Cohen

et al. 2013

Cerebrovasc Dis

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Background: Renal impairment is a potent risk factor for stroke, which remains a leading cause of death and disability. Thrombolysis for acute ischemic stroke has transformed patient outcomes, although the safety and efficacy of this approach remain poorly characterized in patients with renal dysfunction, who manifest a higher risk of bleeding due to uremia. We therefore examined the impact of renal impairment on clinical outcomes with thrombolysis within the current 4.5-hour therapeutic window. Methods: This retrospective multicenter cohort study (2009–2011) examined 229 stroke patients receiving thrombolysis with alteplase (0.9 mg/kg; mean age 70 ± 13 years; 59% male, 24% diabetic). Sixty-five patients had an estimated glomerular filtration rate (eGFR) <60 ml/min. The primary outcome was the improvement in National Institutes of Health Stroke Scale (NIHSS) score at 24 h. Secondary outcomes included the NIHSS score at 7 days, the incidence of symptomatic and asymptomatic intracranial hemorrhage (ICH), extracranial bleeding and death during the index hospitalization. Univariate and multivariate regression analyses were performed to determine the association between demographic characteristics and comorbid factors of interest and outcomes. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Results: There was no significant difference in mean time to thrombolysis between the groups (221 ± 66 vs. 220 ± 70 min from symptom onset; p = 0.9). An eGFR <60 ml/min was independently associated with a statistically significant reduction of the therapeutic effect of alteplase at 24 h on multivariate regression [coefficient –2.3, 95% confidence interval (CI) –3.7 to –0.9; p = 0.002], and this persisted at 7 days (coefficient –3.5, 95% CI –5.3 to –1.7; p < 0.001). On modeling eGFR as a continuous variable, every 10 ml/min decline in eGFR was associated with a 0.40 diminution in NIHSS score improvement with alteplase (95% CI 0.07–0.74; p = 0.02). Older age and a higher presenting NIHSS score were associated with a greater therapeutic effect (p = 0.04 and p < 0.001, respectively). In-patient mortality was 5%, with no significant differences between groups. Renal impairment was not associated with a higher rate of ICH (6.2 vs. 6.7%; p = 0.9). Greater NIHSS score at presentation was the only factor associated with a greater risk of death (odds ratio 1.24, 95% CI 1.10–1.40; p < 0.001) and ICH (odds ratio 1.12, 95% CI 1.03–1.23; p = 0.004). Conclusions: Our results suggest that renal impairment is associated with reduced efficacy of thrombolysis in acute ischemic stroke without any excess hemorrhagic complications. This may relate to diminished fibrinolysis in the uremic milieu or differences in infarct anatomy. Longer-term prospective studies are required to characterize and improve functional outcomes following stroke in a manifestly high-risk group.

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Carotid intima-media thickness and cerebral white matter lesions are more advanced in acute ischemic stroke patients with renal dysfunction

Cited by 14 publications

References 0 publications

High urinary albumin/creatinine ratio at admission predicts poor functional outcome in patients with acute ischaemic stroke

High urinary albumin/creatinine ratio at admission predicts poor functional outcome in patients with acute ischaemic stroke

Is Renal Dysfunction Associated with Adverse Stroke Outcome after Thrombolytic Therapy?

Renal Impairment Reduces the Efficacy of Thrombolytic Therapy in Acute Ischemic Stroke

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