title: Renal dysfunction and thrombolytic therapy in patients with acute ischemic stroke: a systematic review and meta-analysis.
abstract: Renal dysfunction is a prevalent comorbidity in acute ischemic stroke patients requiring thrombolytic therapy. However, the effect of renal dysfunction on the clinical outcome of this population remains controversial. This study aimed to evaluate the safety and effectiveness of thrombolytic therapy in acute stroke patients with renal dysfunction using a meta-analysis. We systematically searched PubMed and EMBASE for studies that evaluated the relationship between renal dysfunction and intravenous tissue plasminogen activator (tPA) in patients with acute ischemic stroke. Poor outcome (modified Rankin Scale≥2), mortality, and symptomatic intracranial hemorrhage (ICH) and any ICH were analyzed. Fourteen studies were included (N=53,553 patients). The mean age ranged from 66 to 75 years. The proportion of male participants was 49% to 74%. The proportion of renal dysfunction varied from 21.9% to 83% according to different definitions. Based on 9 studies with a total of 7796 patients, the meta-analysis did not identify a significant difference in the odds of poor outcome (odds ratio [OR]=1.06; 95% confidence interval [CI]: 0.96-1.16; I=44.5) between patients with renal dysfunction and those without renal dysfunction. Patients with renal dysfunction were more likely to die after intravenous thrombolysis (OR=1.13; 95% CI: 1.05-1.21; I=70.3). No association was observed between symptomatic ICH (OR=1.02; 95% CI: 0.94-1.10; I=0) and any ICH (OR=1.07; 95% CI: 0.96-1.18; I=25.8). Renal dysfunction does not increase the risk of poor outcome and ICH after stroke thrombolysis. Renal dysfunction should not be a contraindication for administration of intravenous thrombolysis to eligible patients.
authors.affiliation: From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, No 37, Guo Xue Xiang, Chengdu 610041, China (ZH, ML, BW); Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, 610041 China (CY).
authors.forename: Zilong
authors.initials: Z
authors.lastname: Hao
authors.forename: Chunsong
authors.initials: C
authors.lastname: Yang
authors.forename: Ming
authors.initials: M
authors.lastname: Liu
authors.forename: Bo
authors.initials: B
authors.lastname: Wu
mesh_terms: D000208:Acute Disease; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014943:Global Health; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D051437:Renal Insufficiency / Q000139:chemically induced / Q000453:epidemiology / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents