title: Outcomes of thrombolytic treatment for acute ischemic stroke in dialysis-dependent patients in the United States.
abstract: OBJECTIVE
  To determine the outcomes of dialysis-dependent renal failure patients who had ischemic stroke and were treated with intravenous (IV) thrombolytics in the United States.
  
  
  METHODS
  We analyzed the data from Nationwide Inpatient Sample (2002-2009) for all thrombolytic-treated patients presenting with acute ischemic stroke with or without dialysis dependence. Patients were identified using the International Classification of Disease, Ninth Revision, Clinical Modification codes. Baseline characteristics, in-hospital complications including secondary intracerebral hemorrhage (ICH), sepsis, pneumonia, pulmonary embolism, deep venous thrombosis, urinary tract infections, and discharge outcomes (mortality, minimal disability, and moderate-to-severe disability) were compared between the groups.
  
  
  RESULTS
  Of the 82,142 patients with ischemic stroke who receive thrombolytic treatment, 1072 (1.3%) was dialysis dependent. The ICH rates did not differ significantly between patients with ischemic stroke with or without dialysis who received thrombolytics (5.2% versus 6.1%). The in-hospital mortality rate was higher in dialysis-dependent patients treated with thrombolytics (22% versus 11%, P≤.0001). After adjusting for age, sex, and comorbidities, dialysis dependence was associated with higher rates of in-hospital mortality in patients treated with thrombolytics (odds ratio, 1.92; 95% confidence interval, 1.33-2.78, P=.0005).
  
  
  CONCLUSIONS
  The 2-fold higher odds of in-hospital mortality associated with administration of IV thrombolytics in dialysis-dependent patients who present with acute ischemic stroke warrant a careful assessment of risk-benefit ratio in this population.
authors: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota; Department of Nephrology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: nomitq@gmail.com.
authors: Nauman
authors: N
authors: Tariq
authors: Malik M
authors: MM
authors: Adil
authors: Fahad
authors: F
authors: Saeed
authors: Saqib A
authors: SA
authors: Chaudhry
authors: Adnan I
authors: AI
authors: Qureshi
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Ischemic stroke; dialysis; renal failure; thrombolysis