title: Does renal dysfunction modify the effect of intravenous thrombolysis for acute ischemic stroke within 4.5 hours of onset? A multicenter observational study.
abstract: BACKGROUND
  About one third of stroke patients have renal dysfunction. Effect of renal dysfunction on outcome of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) has not been determined in Asia using patients without IVT as comparators. The aim of this study was to examine the interaction between renal dysfunction and IVT on the outcomes in AIS patients admitted within 4.5 hours of onset in a multicenter stroke registry of Taiwan.
  
  
  METHODS
  We identified all consecutive AIS patients admitted within 4.5 hours of onset between 2007 and 2013. Renal dysfunction was defined by an estimated glomerular filtration rate less than 60 mL/minute/1.73 m(2) on initial admission. Patients older than 80 years of age and a National Institute of Health Stroke Scale score less than 4 or greater than 25 were excluded. The primary outcome was a modified Rankin Scale score 3-6 at 3 months. We determined the effect of IVT and renal dysfunction on outcome in a multivariate analysis.
  
  
  RESULTS
  Of the 929 patients analyzed, 39% had renal dysfunction, and 51% received IVT. Primary outcomes occurred in 45% versus 41% of patients with and without renal dysfunction, respectively, (P = .197). In a multivariate analysis, the odds ratios (95% confidence interval; P value) of IVT and renal dysfunction for primary outcome were .70 (.51-.96; P = .029) and .97 (.71-1.33; P = .865), respectively. No significant interaction was noted between IVT and renal dysfunction (P = .218).
  
  
  CONCLUSIONS
  Renal dysfunction did not modify the effect of IVT for AIS and should not be a reason for withholding treatment from otherwise-eligible patients.
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.
authors.forename: Cheng-Yang
authors.initials: CY
authors.lastname: Hsieh
authors.affiliation: Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan; Department of Cosmetic Science, Chia Nan University of Pharmacy & Science, Tainan, Taiwan.
authors.forename: Huey-Juan
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan.
authors.forename: Sheng-Feng
authors.initials: SF
authors.lastname: Sung
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Yea-Huei Kao
authors.initials: YH
authors.lastname: Yang
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Edward Chia-Cheng
authors.initials: EC
authors.lastname: Lai
authors.affiliation: Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Hsieh
authors.affiliation: Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: lchih@mail.ncku.edu.tw.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chen
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013624:Taiwan; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Renal dysfunction; cerebral hemorrhage; glomerular filtration rate; thrombolytic therapy; tissue plasminogen activator