The impact of acute kidney injury on in-hospital mortality in acute ischemic stroke patients undergoing intravenous thrombolysis

Background and Purpose: Clinical outcome and mortality after endovascular thrombectomy (EVT) in patients with ischemic stroke are commonly assessed after 3 months. In patients with acute kidney injury (AKI), unfavorable results for 3-month mortality have been reported. However, data on the in-hospital mortality after EVT in this population are sparse. In the present study, we assessed whether AKI impacts in-hospital and 3-month mortality in patients undergoing EVT.Materials and Methods: From a prospectively recruiting database, consecutive acute ischemic stroke patients receiving EVT between 2010 and 2018 due to acute large vessel occlusion were included. Post-contrast AKI (PC-AKI) was defined as an increase of baseline creatinine of ≥0.5 mg/dL or >25% within 48 h after the first measurement at admission. Adjusting for potential confounders, associations between PC-AKI and mortality after stroke were tested in univariate and multivariate logistic regression models.Results: One thousand one hundred sixty-nine patients were included; 166 of them (14.2%) died during the acute hospital stay. Criteria for PC-AKI were met by 29 patients (2.5%). Presence of PC-AKI was associated with a significantly higher risk of in-hospital mortality in multivariate analysis [odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.16–7.13, p = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, p = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, p < 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, p < 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, p < 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, p = 0.001).Conclusion: PC-AKI is rare after EVT but represents an important risk factor for in-hospital mortality and for mortality within 3 months after hospital discharge. Preventing PC-AKI after EVT may represent an important and potentially lifesaving effort in future daily clinical practice.

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Acute Kidney Injury after Endovascular Treatment in Patients with Acute Ischemic Stroke

Journal of Clinical Medicine ◽

10.3390/jcm9051471 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1471

Author(s):

Joonsang Yoo ◽

Jeong-Ho Hong ◽

Seong-Joon Lee ◽

Yong-Won Kim ◽

Ji Man Hong ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Functional Outcomes ◽

Kidney Injury ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Factors Associated

Acute kidney injury (AKI) is often associated with the use of contrast agents. We evaluated the frequency of AKI, factors associated with AKI after endovascular treatment (EVT), and associations with AKI and clinical outcomes. We retrospectively analyzed consecutively enrolled patients with acute ischemic stroke who underwent EVT at three stroke centers in Korea. We compared the characteristics of patients with and without AKI and independent factors associated with AKI after EVT. We also investigated the effects of AKI on functional outcomes and mortality at 3 months. Of the 601 patients analyzed, 59 patients (9.8%) developed AKI and five patients (0.8%) started renal replacement therapy after EVT. In the multivariate analysis, diabetes mellitus (odds ratio (OR), 2.341; 95% CI, 1.283–4.269; p = 0.005), the contrast agent dose (OR, 1.107 per 10 mL; 95% CI, 1.032–1.187; p = 0.004), and unsuccessful reperfusion (OR, 1.909; 95% CI, 1.019–3.520; p = 0.040) were independently associated with AKI. The presence of AKI was associated with a poor functional outcome (OR, 5.145; 95% CI, 2.177–13.850; p < 0.001) and mortality (OR, 8.164; 95% CI, 4.046–16.709; p < 0.001) at 3 months. AKI may also affect the outcomes of ischemic stroke patients undergoing EVT. When implementing EVT, practitioners should be aware of these risk factors.

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Acute Kidney Injury in Acute Ischemic Stroke Patients in Clinical Trials

Critical Care Medicine ◽

10.1097/ccm.0000000000004464 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Adnan I. Qureshi ◽

Hunain Aslam ◽

Werdah Zafar ◽

Wei Huang ◽

Iryna Lobanova ◽

...

Keyword(s):

Acute Kidney Injury ◽

Clinical Trials ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Kidney Injury ◽

Stroke Patients

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Higher diastolic blood pressure at admission and antiedema therapy is associated with acute kidney injury in acute ischemic stroke patients

International Journal of Nephrology and Renovascular Disease ◽

10.2147/ijnrd.s59443 ◽

2014 ◽

pp. 101 ◽

Cited By ~ 3

Author(s):

Hasan Micozkadioglu

Keyword(s):

Blood Pressure ◽

Acute Kidney Injury ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Diastolic Blood Pressure ◽

Kidney Injury ◽

Stroke Patients

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Abstract 132: Acute Kidney Injury in Acute Ischemic Stroke Patients: Pooled Analysis of ALIAS I and II and IMS III Trials

Stroke ◽

10.1161/str.51.suppl_1.132 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Hunain Aslam ◽

Werdah Zafar ◽

Wei Huang ◽

Iryna Lobanova ◽

Farhan Siddiq ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ischemic Stroke ◽

Serum Creatinine ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Kidney Injury ◽

Pooled Analysis ◽

Stroke Patients ◽

Volume Depletion ◽

Ct Angiogram

Background: Acute ischemic stroke patients are at risk of acute kidney injury (AKI) due to volume depletion, contrast exposure and pre-existing co-morbid diseases. We determined the incidence and identified predictors associated with AKI in acute ischemic stroke patients. Methods: Data from the Albumin in Acute Ischemic Stroke trial (ALIAS) - I and II and Interventional Management of Stroke (IMS) - III clinical trials were pooled and analyzed in which acute ischemic stroke patients were randomized into either IV albumin, placebo, endovascular or IV thrombolytic treatment groups. Serum creatinine levels from baseline and within day 5 or discharge along with the demographic and comorbidity information was collected. AKI classification was used to ascertain severity of renal dysfunction and based on increase in serum creatinine levels from baseline, stage 1 ≥ 0.3 mg/dl (≥ 26.4umol/L) or (>1.5 to 2-fold), stage 2 (>2 to 3-fold) and stage 3 (>3-fold) were identified. We analyzed the relationship between AKI and mortality at 3 months post randomization. Results: A total of 1931 acute ischemic stroke patients (mean age 66± 13 (SD) years; 1024 were men) were analyzed. Any increase in serum creatinine was seen in 691 (35.8%, 95% CI 30%-40%) and AKI was seen in 68 (3.5%, 95% CI 3%-4%) of 1931 patients. Severity of AKI was grade I, II, III in 2.1 %, 0.4%, and 0.1% patients, respectively. The risk of AKI was not higher between those who either underwent CT angiography (2% compared with 4.2%, RR 0.5, 95% CI 0.3-0.8, p=0.02) or endovascular treatment (1.9% compared with 4.1%, RR 0.4, 95% CI 0.2-0.8, p=0.0096). Patients with preexisting hypertension (4.3% compared to 1.5%, RR 2.8, 95% CI 1.3-5.7, p=0.006) and preexisting renal disease (9.1% compared to 3.0%, RR 3.1, 95% CI 1.8-5.3, p=0.006) had higher risk of AKI. Mortality at 3 months was significantly higher among patients with AKI (27% compared with 15%, RR 1.8, 95% CI 1.2-2.7, p=0.0083). Conclusions: The incidence of AKI in acute ischemic stroke patients was low and was not higher in patients who underwent CT angiogram or those who received endovascular treatment. Occurrence of AKI increased mortality at 3 months among acute ischemic stroke patients.

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Sex and Hemisphere - A Neglected, Nature-Determined Relationship in Acute Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000430999 ◽

2015 ◽

Vol 40 (1-2) ◽

pp. 59-66 ◽

Cited By ~ 3

Author(s):

Christian Hametner ◽

Peter Ringleb ◽

Lars Kellert

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Specific Treatment ◽

Intravenous Thrombolysis ◽

Ordinal Regression ◽

Matched Cohort ◽

Exact Matching ◽

Stroke Patients ◽

Good Outcome ◽

The Impact

Background: Sex differences in the structural connectome of the brain are clinically highly relevant, but they have mostly been neglected in stroke trials. We investigated the impact of the interaction sex-by-hemisphere on outcome in stroke patients after intravenous thrombolysis (IVT). Methods: This is an observational study based on consecutively collected supratentorial stroke patients treated with IVT (n = 1,231). The 3-month modified Rankin scale (mRS) was estimated by adjusted binary (mRS 0-2 for good outcome) and ordinal regression analysis. As baseline characteristics differ substantially between the sexes, we aimed for better covariate balance by employing coarsened exact matching. Results: Sex-by-hemisphere predicted good outcome in the entire cohort (726 left, 505 right hemispheric strokes, p valueinteraction 0.032) and in the matched cohort (338 left, 273 right, p valueinteraction 0.003). Ordinal regression suggested a comparable estimate in the matched cohort (p valueinteraction 0.006). Further investigation revealed relevant between-sex and within-sex risk: right hemispheric strokes in men were 1.54 times (95% confidence intervals (CIs) 1.15-2.01) more likely than in women to achieve mRS 0-2. Women with right hemispheric strokes were 0.72 times (95% CI 0.54-0.92) less likely to reach mRS 0-2 than women with left hemispheric strokes. Conversely, men with right hemispheric strokes were 1.35 times (95% CI 1.06-1.70) more likely to achieve mRS 0-2 than men with left hemispheric strokes. Conclusion: This study suggests that outcomes are different in both sexes after IVT when different hemispheres are affected. Further consideration of this hypothesis in clinical trials might help in guiding individualized, injury-specific treatment approaches for acute ischemic stroke.

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Incidence and Risk Factors of Postcontrast Acute Kidney Injury in Patients with Acute Ischemic Stroke

Stroke Research and Treatment ◽

10.1155/2020/7182826 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Sirichai Chusiri ◽

Aurauma Chutinet ◽

Nijasri Charnnarong Suwanwela ◽

Chankit Puttilerpong

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Kidney Injury ◽

Stroke Patients ◽

Two Factors ◽

Real Practice ◽

Multimodal Ct

Background. Multimodal computed tomography (CT) guides decision-making regarding use of thrombolytic agents in acute ischemic stroke patients. However, postcontrast acute kidney injury (PC-AKI) is a potential adverse effect of the contrast media used, which may require hemodialysis and cause a longer hospital stay. The incidence and risk factors of PC-AKI in acute ischemic stroke patients, particularly in Thailand, remain unclear. Goal. We aimed at determining the incidence and risk factors of PC-AKI in patients with acute ischemic stroke undergoing multimodal CT. Methods. We conducted a retrospective review of Thai acute ischemic stroke patients admitted to the King Chulalongkorn Memorial Hospital between January 2014 and December 2017 who received multimodal CT and thrombolytic treatment with alteplase. Result. Overall, 109 patients were included for analysis; eight patients (7.3%) developed PC-AKI. Estimated glomerular filtration rate eGFR≤30 mL/min and mechanical thrombectomy were risk factors significantly associated with PC-AKI. Conclusion. The incidence of PC-AKI in a real practice setting did not differ from previous reports. Two factors were associated with PC-AKI, eGFR≤30 mL/min and mechanical thrombectomy. Patients without these risk factors may not need to wait for the results of renal function testing prior to multimodal CT.

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Abstract 203: Acute Kidney Injury in Acute Ischemic Stroke Patients Receiving Endovascular Treatment: Analysis of the Interventional Management of Stroke (IMS) - III

Stroke ◽

10.1161/str.47.suppl_1.203 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Nabeel A Herial ◽

Muhammad A Saleem ◽

Muhammad Shah Miran ◽

Adnan I Qureshi

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Ischemic Stroke ◽

Serum Creatinine ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Kidney Injury ◽

Stroke Patients ◽

Intravenous Treatment ◽

Stage 1

Background: Endovascular treatment involves cerebral angiography with injection of contrast agents that are nephrotoxic and carry risk of renal failure. Our objective was to determine the incidence and identify predictors associated with acute kidney injury in ischemic stroke patients undergoing endovascular treatment. Materials and methods: Data from the Interventional Management of Stroke (IMS) - III clinical trial was utilized in which acute ischemic stroke patients were randomized into endovascular or intravenous treatment groups. Baseline and day 5 or discharge serum creatinine levels along with the demographic and comorbidity information was collected. Acute Kidney Injury classification was used to ascertain severity of renal dysfunction and based on increase in Day 5 creatinine levels from baseline, stage 1 (1.5 to 2 fold), stage 2 (>2 to 3 fold), and stage 3 renal failure (>3 fold increase from baseline) were identified. Results: Total of 434 patients received ET and 222 patients received intravenous treatment (IVT) with tissue plasminogen activator (tPA). Increase in serum creatinine levels was observed in 52 patients (12%) receiving ET and 24 patients (11%) in the IVT group. Renal failure (stage 1 or higher) was observed in 5 patients (1.2%) in the ET group and 3 patients (1.4%) in the IVT group. In univariate analysis, only age was associated with higher incidence of renal failure in the ET group. No significant association was observed with comorbid diagnoses, particularly pre-existing hypertension or diabetes mellitus. Baseline creatinine level was associated with renal failure (p=0.029) in patients receiving ET and pre-existing diagnosis of renal disorders was associated with renal failure in patients receiving IVT. Conclusions: In the IMS III data, incidence of acute kidney injury in acute ischemic stroke was low and was not different from patients receiving IVT.

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Safety of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients with Thrombocytopenia

Cerebrovascular Diseases ◽

10.1159/000504214 ◽

2019 ◽

Vol 48 (3-6) ◽

pp. 157-164 ◽

Cited By ~ 1

Author(s):

Yifeng Yang ◽

Baoqiong Liu ◽

Lingling Wu ◽

Xuan Guan ◽

Yiming Luo ◽

...

Keyword(s):

Mechanical Ventilation ◽

Ischemic Stroke ◽

Length Of Stay ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Multivariate Regression ◽

Intravenous Thrombolysis ◽

Hospital Length Of Stay ◽

The Impact

Background: Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is an effective treatment of acute ischemic stroke (AIS). The safety of intravenous rtPA in patients with thrombocytopenia is unclear. This study sought to evaluate the impact of thrombocytopenia on in-hospital outcomes in patients with AIS who received intravenous thrombolysis. Methods: This was a retrospective study using the 2012–2014 National Inpatient Sample (20% stratified sample of US hospitals). The study identified adult patients admitted with AIS who received intravenous rtPA during hospitalization. The identified admissions were stratified into 2 cohorts based on the presence or absence of thrombocytopenia. Multilevel, multivariate regression analysis and propensity matching were performed to evaluate in-hospital mortality, length of stay, and in-hospital complications. Results: Of 101,527 patients admitted for AIS and received intravenous rtPA from 2012 to 2014, 3,520 (3.47%) had thrombocytopenia. In-hospital mortality was 10.8 vs. 6.9% in patients with and without thrombocytopenia in original data, p < 0.001. In-hospital length of stay was significantly higher in the thrombocytopenia group (5.9 vs. 8.2 days, p < 0.001). The differences were significant in both the multivariate regression model and the propensity score matching model. Patients with thrombocytopenia also had a statistically higher incidence of intracranial hemorrhage, postprocedural bleeding, blood transfusion, tracheotomy, and mechanical ventilation. Conclusion: Thrombocytopenia is associated with higher in-hospital mortality, longer length of stay, a higher incidence of intracranial hemorrhage, postprocedural bleeding, and mechanical ventilation in stroke patients who received intravenous rtPA.

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