Favourable renal outcomes after intravenous thrombolytic therapy for acute ischemic stroke: Clinical implication of kidney–brain axis

다국어 초록 (Multilingual Abstract)

Recombinant tissue plasminogen activator (rt‐PA) administration is the most prevalent treatment for acute ischemic within golden time. However, the effects of rt‐PA on the kidney function in such patients remain unknown. This study determined long‐term renal outcomes in patients with acute ischemic stroke receiving systemic rt‐PA.
We enroled patients who were hospitalized for acute ischemic stroke from January 2001 to January 2017. We applied 1:2 propensity score matching to eliminate various confounding variables. We defined surrogate renal outcomes as declining of estimated glomerular filtration rate (eGFR) greater than 30% and 50%, and chronic kidney disease (CKD) with eGFR less than 60 mL/min. We then compared the 1‐year eGFR with paired t‐test in patients treated with or without rt‐PA.
Overall, 343 of 1739 patients received rt‐PA within golden time. After 1:2 propensity score matching, their baseline characteristics were grouped as treated with rt‐PA (n = 235) or not (n = 394). rt‐PA‐treated patients exhibited slower renal progression, including the risk of eGFR declining greater than 30% (hazard ratio (HR), 0.72; P = 0.03), risk of declining eGFR greater than 50% (HR, 0.63; P = 0.046) and risk of CKD (HR, 0.61; P = 0.005). After 1‐year cohort, the rt‐PA group exhibited an improved renal outcome by the paired t‐test (propensity match: ΔGFR = 9.1 (95% confidence interval: 6.3, 11.8), P < 0.001 in rt‐PA group; ΔGFR = −1.1 (95% confidence interval: −2.9, 0.7), P = 0.23 in non‐rt‐PA group). In patients with eGFR less than 45 mL/min (n = 34), intracerebral haemorrhage was not reported.
Patients receiving rt‐PA for acute ischemic stroke exhibit favourable renal outcomes, and no increased incidence of intracerebral haemorrhage occurs in rt‐PA patients with advanced CKD.
The authors hypothesize that neuro‐hormonal responses to ischaemic brain injury in stroke may affect kidney function. They compared changes in kidney function over time in patients treated with thrombolysis to those who were not. In these observational data, kidney function deteriorated less in patients who received thrombolysis for stroke.