title: Severe renal impairment is associated with symptomatic intracerebral hemorrhage after thrombolysis for ischemic stroke.
abstract: OBJECTIVE
  Patients with renal impairment (RI) have an increased risk of both thrombotic and hemorrhagic events. We aimed to clarify whether RI increases the risk of intracerebral hemorrhage (ICH) after intravenous thrombolysis with recombinant tissue plasminogen activator.
  
  
  METHODS
  Patients who received intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 hours of symptom onset were retrospectively analyzed. Creatinine levels on admission served to calculate glomerular filtration rate (GFR) to estimate RI according to International Classification of Diseases criteria. Effect of RI on symptomatic ICH (sICH) was assessed using dichotomized (GFR <90 and <30 mL/min) and continuous GFR (centered data to test for linear and centered and squared data to test for curvilinear association).
  
  
  RESULTS
  Of the 740 patients included, 83% had any RI (GFR <90 mL/min) and 5% had severe RI (GFR <30 mL/mL); 4.6% experienced sICH. Univariate comparisons revealed higher prevalence of sICH in patients with severe RI (P<0.01) but not with any RI. GFR as a continuous variable (centered and squared) was also associated with sICH (P=0.02), but GFR on its own was not. Severe RI and GFR (centered and squared) remained independently associated with sICH in multiple regression analyses.
  
  
  CONCLUSIONS
  Severe RI (GFR <30 mL/min) is associated with sICH after intravenous thrombolysis with recombinant tissue plasminogen activator. The association is curvilinear. Severe RI must be taken into account when balancing the risk-benefit ratio of intravenous thrombolysis with recombinant tissue plasminogen activator.
authors.affiliation: From the Departments of Neurology (S.T., A.M.Z., J.F.S., A.R., M.E., C.H.N.) and Nephrology (T.S.), Charité Universitaetsmedizin Berlin, Germany.
authors.forename: Serdar
authors.initials: S
authors.lastname: Tütüncü
authors.forename: Annerose M
authors.initials: AM
authors.lastname: Ziegler
authors.forename: Jan F
authors.initials: JF
authors.lastname: Scheitz
authors.forename: Torsten
authors.initials: T
authors.lastname: Slowinski
authors.forename: Andrea
authors.initials: A
authors.lastname: Rocco
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications*; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000150:complications / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: acute renal failure; cerebral hemorrhage; stroke; thrombolytic therapy