title: IV thrombolysis and renal function.
abstract: OBJECTIVE
  To investigate the association of renal impairment on functional outcome and complications in stroke patients treated with IV thrombolysis (IVT).
  
  
  METHODS
  In this observational study, we compared the estimated glomerular filtration rate (GFR) with poor 3-month outcome (modified Rankin Scale scores 3-6), death, and symptomatic intracranial hemorrhage (sICH) based on the criteria of the European Cooperative Acute Stroke Study II trial. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Patients without IVT treatment served as a comparison group.
  
  
  RESULTS
  Among 4,780 IVT-treated patients, 1,217 (25.5%) had a low GFR (<60 mL/min/1.73 m(2)). A GFR decrease by 10 mL/min/1.73 m(2) increased the risk of poor outcome (OR [95% CI]): (ORunadjusted 1.20 [1.17-1.24]; ORadjusted 1.05 [1.01-1.09]), death (ORunadjusted 1.33 [1.28-1.38]; ORadjusted 1.18 [1.11-1.249]), and sICH (ORunadjusted 1.15 [1.01-1.22]; ORadjusted 1.11 [1.04-1.20]). Low GFR was independently associated with poor 3-month outcome (ORadjusted 1.32 [1.10-1.58]), death (ORadjusted 1.73 [1.39-2.14]), and sICH (ORadjusted 1.64 [1.21-2.23]) compared with normal GFR (60-120 mL/min/1.73 m(2)). Low GFR (ORadjusted 1.64 [1.21-2.23]) and stroke severity (ORadjusted 1.05 [1.03-1.07]) independently determined sICH. Compared with patients who did not receive IVT, treatment with IVT in patients with low GFR was associated with poor outcome (ORadjusted 1.79 [1.41-2.25]), and with favorable outcome in those with normal GFR (ORadjusted 0.77 [0.63-0.94]).
  
  
  CONCLUSIONS
  Renal function significantly modified outcome and complication rates in IVT-treated stroke patients. Lower GFR might be a better risk indicator for sICH than age. A decrease of GFR by 10 mL/min/1.73 m(2) seems to have a similar impact on the risk of death or sICH as a 1-point-higher NIH Stroke Scale score measuring stroke severity.
authors.affiliation: From the Departments of Neurology (H.G., D.J.S., N.P., L.H.B., P.A.L., S.T.E.), University Hospital Basel, Switzerland; Academic Medical Center (S.M.Z., Y.B.R., P.J.N.), University of Amsterdam, the Netherlands; University of Heidelberg (P.R.), Germany; Helsinki University Central Hospital (V.A., J.P., E.H., T.T.), Finland; University Lille North de France (D.L., R.B.), UDSL (EA1046), France; Centre Hospitalier Universitaire Vaudois and University of Lausanne (P.M., C.O.), Switzerland; Municipal Hospital Altenburg (J.B.), Germany; University Hospital Bern (M.A., M.R.H., H.S.), Switzerland; AUSL Modena (A.Z., G.B.), Italy; Clinical Center (V.P.), School of Medicine, University of Belgrade, Serbia; University Hospital Brescia (A.P.), Italy; Swiss Tropical and Public Health Institute (C.S.), University of Basel, Switzerland; University Hospital Zurich (H.S.), Switzerland.
authors.forename: Henrik
authors.initials: H
authors.lastname: Gensicke
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Zinkstok
authors.forename: Yvo B
authors.initials: YB
authors.lastname: Roos
authors.forename: David J
authors.initials: DJ
authors.lastname: Seiffge
authors.forename: Peter
authors.initials: P
authors.lastname: Ringleb
authors.forename: Ville
authors.initials: V
authors.lastname: Artto
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.forename: Elena
authors.initials: E
authors.lastname: Haapaniemi
authors.forename: Didier
authors.initials: D
authors.lastname: Leys
authors.forename: Régis
authors.initials: R
authors.lastname: Bordet
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.forename: Céline
authors.initials: C
authors.lastname: Odier
authors.forename: Jörg
authors.initials: J
authors.lastname: Berrouschot
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Mirjam R
authors.initials: MR
authors.lastname: Heldner
authors.forename: Andrea
authors.initials: A
authors.lastname: Zini
authors.forename: Guido
authors.initials: G
authors.lastname: Bigliardi
authors.forename: Visnja
authors.initials: V
authors.lastname: Padjen
authors.forename: Nils
authors.initials: N
authors.lastname: Peters
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pezzini
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.forename: Hakan
authors.initials: H
authors.lastname: Sarikaya
authors.forename: Leo H
authors.initials: LH
authors.lastname: Bonati
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: Philippe A
authors.initials: PA
authors.lastname: Lyrer
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Engelter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000139:chemically induced*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed