Impact of Renal Function on Short-Term Outcome After Reperfusion Therapy in Patients With Ischemic Stroke

Abstract

BACKGROUND: A high and low estimated glomerular filtration rate (eGFR) could affect outcomes after reperfusion therapy for ischemic stroke. This study aimed to determine whether renal function based on eGFR affects mortality risk in patients with ischemic stroke within 6 months following reperfusion therapy. METHODS: This prospective registry–based cohort study included 2266 patients who received reperfusion therapy between January 2000 and September 2019 and were registered in the SECRET (Selection Criteria in Endovascular Thrombectomy and Thrombolytic Therapy) study or the Yonsei Stroke Cohort. A high and low eGFR were based on the Chronic Kidney Disease Epidemiology Collaboration equation and defined, respectively, as the 5th and 95th percentiles of age- and sex-specific eGFR. Occurrence of death within 6 months was compared among the groups according to their eGFR such as low, normal, or high eGFR. RESULTS: Of the 2266 patients, 2051 (90.5%) had a normal eGFR, 110 (4.9%) a low eGFR, and 105 (4.6%) a high eGFR. Patients with high eGFR were younger or less likely to have hypertension, diabetes, or atrial fibrillation than the other groups. Active cancer was more prevalent in the high-eGFR group. During the 6-month follow-up, there were 24 deaths (22.9%) in the high-eGFR group, 37 (33.6%) in the low-eGFR group, and 237 (11.6%) in the normal-eGFR group. After adjusting for variables with P <0.10 in the univariable analysis, 6-month mortality was independently associated with high eGFR (hazard ratio, 2.22 [95% CI, 1.36–3.62]; P =0.001) and low eGFR (HR, 2.29 [95% CI, 1.41–3.72]; P =0.001). These associations persisted regardless of treatment modality or various baseline characteristics. CONCLUSIONS: High eGFR as well as low eGFR were independently associated with 6-month mortality after reperfusion therapy. Kidney function could be considered a prognostic factor in patients with ischemic stroke after reperfusion therapy.

Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function

“…The estimated glomerular filtration rate (eGFR) was calculated from the serum creatinine by the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equation 13 . The new CKD‐EPI equation was specially adjusted for the Asian population 8 . Patient groups were divided into patients with normal renal function as defined by eGFR ≥90 mL/min/1.73 m 2 and patients with renal insufficiency defined by eGFR <90 mL/min/1.73 m 2 .…”

“… 13 The new CKD‐EPI equation was specially adjusted for the Asian population. 8 Patient groups were divided into patients with normal renal function as defined by eGFR ≥90 mL/min/1.73 m 2 and patients with renal insufficiency defined by eGFR <90 mL/min/1.73 m 2 .…”

“…7 Park et al found an increased frequency of ischemic complications including in-hospital death and poor outcomes among LVO patients with renal insufficiency. 8 More recent evidence has suggested that stroke subtypes were differentially distributed across different strata of renal function and modulated the prognostic value of renal function among ischemic stroke patients. 9 In addition, tirofiban is also renally cleared and the presence of renal dysfunction might lead to the accumulation of tirofiban in serum, potentially increasing the incidence of bleeding complications.…”

“…Park et al. found an increased frequency of ischemic complications including in‐hospital death and poor outcomes among LVO patients with renal insufficiency 8 . More recent evidence has suggested that stroke subtypes were differentially distributed across different strata of renal function and modulated the prognostic value of renal function among ischemic stroke patients 9 .…”

Kidney dysfunction predicts 90 days mortality after stroke thrombectomy independent of cardiovascular risk factors and chronic kidney disease

“…However, as summarized in a recent review article, data on the effect of KD on outcome of endovascular stroke treatment is still limited, with only eleven studies on the topic 10 and one more publication since. 11 Most previous studies use a single time point measurement with a cut-off of glomerular filtration rate (GFR) of 60 ml/min/1.73 m 2 as a definition of KD. Reasons for decreased GFR in the acute stroke setting are multiple and often reversible.…”