Influence of renal function on stroke outcome after mechanical thrombectomy: a prospective cohort study

Abstract

Background: For acute ischemic stroke (AIS) patient receiving mechanical thrombectomy (MT), renal dysfunction was an independent risk factor of contrast-induced nephropathy which may affect clinical outcomes. However, the influence of renal function on stroke outcomes is still controversial. Thus, we aim to investigate the association between renal function and outcomes of AIS patients receiving MT. Methods: All consecutive stroke patients receiving MT were included in a prospective stroke registry in China from April 2015 to February 2019. Estimated glomerular filtration rate (eGFR) was measured on admission and categorized into G1 (≥ 90 ml/min/1.73 m 2), G2 (60-89 ml/min/1.73 m 2), G3a (45-59 ml/min/1.73 m 2) and G3b-5 (≤44 ml/min/1.73 m 2). Multivariable logistic regression analysis was performed to evaluate the association between eGFR and recanalization rate (thrombolysis in cerebral infarction scale 2b-3), symptomatic intracranial hemorrhage (sICH), death in hospital, death at 3 months and poor functional outcome (modified Rankin Scale 3-6 at 3 months). Results: A total of 373 patients were included in the study. Of them, 130 (34.9%) patients were in the eGFR group G1, 170 (45.6%) in G2, 46 (12.3%) in G3a, 27 (7.2%) in G3b-5. In multivariable logistic regression analysis, reduced eGFR was associated with increased risk of sICH (G3a, p = 0.016) and 3-month death (G3b-5, p = 0.025). However, no significant effects were observed between reduced eGFR and the risk of recanalization rate (p = 0.855), death in hospital (p = 0.970), and poor functional outcome (p = 0.644). Conclusions: For AIS patients underwent MT, reduced eGFR was associated with increased risk of sICH and 3month death. However, there were no appreciable effects of reduced eGFR on recanalization rate, death in hospital and 3-month functional outcome.

Acute and Chronic Kidney Dysfunction and Outcome After Stroke Thrombectomy

“…While the rate of such a reduced eGFR at admission was significantly higher in our patients (31.8% compared to 15.8%), numerous other significant heterogeneities exist between these studies, including differences in demographics, underlying vascular risk factors and stroke etiologies, much faster recanalization times in our study, and ethnic differences, rendering a direct comparison difficult. Two other cohort studies also did not find an effect of baseline kidney function on the 3-month functional outcome in stroke patients treated with MT, while a fourth one did [5][6][7]. Aside from investigating kidney parameters at baseline, our study expands on multiple measurements of kidney function, thus allowing the important differentiation between CKD and AKI as mentioned before.…”

“…Previous studies investigating kidney function in stroke patients mostly focused on eGFR values at admission alone and limited their analysis to a dichotomization of eGFR into values below or above 60 ml/min/1.73 m 2 [4][5][6][7], obviating a differentiation between pre-existing CKD or AKI. However, these represent two entities, which constitute rather different clinical situations and consequences.…”

“…So far, only few studies have investigated whether impaired kidney function at admission would be associated with worse outcome after MT, yielding rather diverging results. While two of them reported worse functional outcome in patients with a baseline estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m 2 , two others found no difference in functional neurological outcome using this eGFR dichotomization [4][5][6][7]. Altogether, these studies are limited by the sole investigation of kidney function at hospital admission and therefore were not able to distinguish between patients with chronic kidney disease (CKD) or acute kidney injury (AKI), the latter representing a more dynamic and potentially reversible condition.…”

Renal impairment and the prognosis of endovascular thrombectomy: a meta-analysis and systematic review

“…Laible et al 21 and Xiao et al 16 found that RI (eGFR < 60 ml/min/1.73 m 2 for Laible et al and eGFR ⩽ 60 ml/min/1.73 m 2 for Xiao et al ) was not associated with sICH (ECASS II for Laible et al and Heidelberg Bleeding Classification for Xiao et al ); the ORs (95% CIs) were 0.66 (0.25–1.76) and 1.16 (0.66–2.07), respectively. However, Pan et al 18 found that RI (eGFR < 60 ml/min/1.73 m 2 ) was associated with an increased risk of sICH (ECASS II; OR, 2.84; 95% CI, 1.41–5.73).…”

Stroke Care During the COVID-19 Pandemic: Asian Stroke Advisory Panel Consensus Statement

“…33 While COVID-19 patients may have renal dysfunction, 32 there is conflicting evidence on the effects of renal dysfunction on outcome after thrombectomy for acute ischemic stroke. 34, 35…”