Thrombolysis in Acute Ischaemic Stroke Patients with Chronic Kidney Disease

Tiberiu Pana; Jonathan Quinn; Mohamed O. Mohamed; Mamas A Mamas; Phyo Kyaw Myint

doi:10.1111/ane.13513

Thrombolysis in Acute Ischaemic Stroke Patients with Chronic Kidney Disease

Tiberiu Pana^* (Corresponding Author), Jonathan Quinn, Mohamed O. Mohamed, Mamas A Mamas, Phyo Kyaw Myint

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

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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.

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	https://doi.org/10.1111/ane.13513
Publication status	Published - 31 Dec 2021

Bibliographical note

ACKNOWLEDGEMENTS
We would like to acknowledge the HCUP Data Partners (https://www.hcup3 us.ahrq.gov/db/hcupdatapartners.jsp).
FUNDING
JQ received the Leslie Wilson Scholarship as part of the Aberdeen Summer Research
Scholarship Programme of the Aberdeen Clinical Academic Training (ACAT) Pathways. The Leslie Wilson Scholarship is funded by the Department of Medicine for the Elderly, NHS Grampian

Keywords

Ischaemic Stroke
Chronic Kidney Disease
Thrombolysis
In-hospital Mortality

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Pana_etal_ANS_Thrombolysis_In_Acute_AAM
This is the peer reviewed version of the following article: Pana, TA, Quinn, J, Mohamed, MO, Mamas, MA, Myint, PK. Thrombolysis in acute ischaemic stroke patients with chronic kidney disease. Acta Neurol Scand. 2021; 00: 1– 11, which has been published in final form at https://doi.org/10.1111/ane.13513. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Accepted author manuscript, 744 KBLicence: Unspecified

Cite this

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title = "Thrombolysis in Acute Ischaemic Stroke Patients with Chronic Kidney Disease",

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. ",

keywords = "Ischaemic Stroke, Chronic Kidney Disease, Thrombolysis, In-hospital Mortality",

author = "Tiberiu Pana and Jonathan Quinn and Mohamed, {Mohamed O.} and Mamas, {Mamas A} and Myint, {Phyo Kyaw}",

note = "ACKNOWLEDGEMENTS We would like to acknowledge the HCUP Data Partners (https://www.hcup3 us.ahrq.gov/db/hcupdatapartners.jsp). FUNDING JQ received the Leslie Wilson Scholarship as part of the Aberdeen Summer Research Scholarship Programme of the Aberdeen Clinical Academic Training (ACAT) Pathways. The Leslie Wilson Scholarship is funded by the Department of Medicine for the Elderly, NHS Grampian",

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doi = "10.1111/ane.13513",

language = "English",

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T1 - Thrombolysis in Acute Ischaemic Stroke Patients with Chronic Kidney Disease

AU - Pana, Tiberiu

AU - Quinn, Jonathan

AU - Mohamed, Mohamed O.

AU - Mamas, Mamas A

AU - Myint, Phyo Kyaw

N1 - ACKNOWLEDGEMENTS We would like to acknowledge the HCUP Data Partners (https://www.hcup3 us.ahrq.gov/db/hcupdatapartners.jsp). FUNDING JQ received the Leslie Wilson Scholarship as part of the Aberdeen Summer Research Scholarship Programme of the Aberdeen Clinical Academic Training (ACAT) Pathways. The Leslie Wilson Scholarship is funded by the Department of Medicine for the Elderly, NHS Grampian

PY - 2021/12/31

Y1 - 2021/12/31

N2 - 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.

AB - 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.

KW - Ischaemic Stroke

KW - Chronic Kidney Disease

KW - Thrombolysis

KW - In-hospital Mortality

U2 - 10.1111/ane.13513

DO - 10.1111/ane.13513

M3 - Article

C2 - 34328648

SN - 0001-6314

VL - 144

SP - 669

EP - 679

JO - Acta Neurologica Scandinavica

JF - Acta Neurologica Scandinavica

IS - 6

ER -

Thrombolysis in Acute Ischaemic Stroke Patients with Chronic Kidney Disease

Abstract

Bibliographical note

Keywords

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