Abstract
Objective: We aimed to determine whether chronic kidney disease (CKD) is associated with adverse in-hospital outcomes after acute ischaemic stroke (AIS) and whether this association is dependent on thrombolysis administration.
Methods: 885,537 records representative of 4,283,086 AIS admissions were extracted from the US National Inpatient Sample (2005-2015) and categorised into 3 mutually exclusive groups: no CKD, CKD without end-stage renal disease (ESRD) and ESRD. Outcomes (mortality, prolonged hospitalisation >4 days and disability on discharge -derived using discharge destination as a proxy) were compared between groups using multivariable logistic regressions. Separate models containing interaction terms with thrombolysis were also computed.
Results:
The median age (interquartile range) of the cohort was 73 (61-83) years and 47.32% were men. Compared to the no CKD group, both CKD/no ESRD group (odds ratio (99% confidence interval) = 1.04 (1.0003-1.09), P=0.009) and the ESRD groups (2.06 (1.90-2.25), P<0.001) had significantly increased odds of in-hospital mortality. Patients with CKD/No ESRD (1.03 (1.02-1.06), P<0.001) and ESRD (1.44 (1.37-1.51), P<0.001) were at higher odds of prolonged hospitalisation. Patients with CKD/No ESRD (1.13 (1.10-1.15), P<0.001)and ESRD (1.34 (1.26-1.41), P<0.001) were also at higher odds of moderate-to-severe disability on discharge. Interaction terms between thrombolysis and the CKD/ESRD groups were not statistically significant (P>0.01) for any outcome.
Conclusions:
Renal dysfunction was independently associated with worse in-hospital outcomes in the acute phase of AIS. These associations were not influenced by the use of thrombolysis as emergency treatment for AIS. CKD/ESRD should not represent sole contraindications to thrombolysis for AIS.
Methods: 885,537 records representative of 4,283,086 AIS admissions were extracted from the US National Inpatient Sample (2005-2015) and categorised into 3 mutually exclusive groups: no CKD, CKD without end-stage renal disease (ESRD) and ESRD. Outcomes (mortality, prolonged hospitalisation >4 days and disability on discharge -derived using discharge destination as a proxy) were compared between groups using multivariable logistic regressions. Separate models containing interaction terms with thrombolysis were also computed.
Results:
The median age (interquartile range) of the cohort was 73 (61-83) years and 47.32% were men. Compared to the no CKD group, both CKD/no ESRD group (odds ratio (99% confidence interval) = 1.04 (1.0003-1.09), P=0.009) and the ESRD groups (2.06 (1.90-2.25), P<0.001) had significantly increased odds of in-hospital mortality. Patients with CKD/No ESRD (1.03 (1.02-1.06), P<0.001) and ESRD (1.44 (1.37-1.51), P<0.001) were at higher odds of prolonged hospitalisation. Patients with CKD/No ESRD (1.13 (1.10-1.15), P<0.001)and ESRD (1.34 (1.26-1.41), P<0.001) were also at higher odds of moderate-to-severe disability on discharge. Interaction terms between thrombolysis and the CKD/ESRD groups were not statistically significant (P>0.01) for any outcome.
Conclusions:
Renal dysfunction was independently associated with worse in-hospital outcomes in the acute phase of AIS. These associations were not influenced by the use of thrombolysis as emergency treatment for AIS. CKD/ESRD should not represent sole contraindications to thrombolysis for AIS.
| Original language | English |
|---|---|
| Pages (from-to) | 669-679 |
| Number of pages | 11 |
| Journal | Acta Neurologica Scandinavica |
| Volume | 144 |
| Issue number | 6 |
| Early online date | 30 Jul 2021 |
| DOIs | |
| Publication status | Published - 31 Dec 2021 |
Keywords
- Ischaemic Stroke
- Chronic Kidney Disease
- Thrombolysis
- In-hospital Mortality