title: Chronic kidney disease and intravenous thrombolysis in acute stroke: A systematic review and meta-analysis.
abstract: BACKGROUND
  The association between chronic kidney disease (CKD) and hemorrhagic complications or clinical outcomes in patients treated with intravenous (IV) thrombolytic agents is controversial.
  
  
  METHODS
  We searched multiple databases for studies on the association between CKD and symptomatic intracerebral hemorrhage (ICH) and/or clinical outcomes in acute stroke patients treated with IV tissue plasminogen activator (tPA). Observational studies that evaluated the association between CKD and outcomes after adjusting for other confounding factors were eligible. We assessed study quality and performed a meta-analysis. The main outcome was symptomatic ICH. The secondary outcomes were poor functional status at 3 months using the modified Rankin Scale, mortality at 3 months, and any ICH.
  
  
  RESULTS
  Seven studies were selected based on our eligibility criteria. Of 7168 patients treated with IV tPA, 2001 (27.9%) had CKD. Patients with CKD had a higher risk of symptomatic ICH and mortality [pooled odds ratio (OR) 1.56, 95% confidence interval (CI) 1.05-2.33 and pooled OR 1.70, 95% CI 1.03-2.81, respectively]. Patients with CKD were likely to have an increased risk of poor outcome at 3 months. There was no significant association between CKD and any ICH.
  
  
  CONCLUSIONS
  Chronic kidney disease may significantly affect symptomatic hemorrhagic complications and poor clinical outcomes following administration of IV tPA.
authors.affiliation: Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
authors.forename: Jin-Man
authors.initials: JM
authors.lastname: Jung
authors.affiliation: Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
authors.forename: Hyeongsik
authors.initials: H
authors.lastname: Ahn
authors.affiliation: Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea; Department of Literary Arts, Brown University, RI, USA.
authors.forename: Il Min
authors.initials: IM
authors.lastname: Ahn
authors.affiliation: Department of Neurology, Daegu Catholic Hospital, Dae-Gu Catholic University College of Medicine, Dae-Gu, Republic of Korea.
authors.forename: Youngrok
authors.initials: Y
authors.lastname: Do
authors.affiliation: Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
authors.forename: Jeong-Yoon
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Woo-Keun
authors.initials: WK
authors.lastname: Seo
authors.affiliation: Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyungmi
authors.initials: K
authors.lastname: Oh
authors.affiliation: Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung-Hee
authors.initials: KH
authors.lastname: Cho
authors.affiliation: Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea. Electronic address: song4yu@korea.ac.kr.
authors.forename: Sungwook
authors.initials: S
authors.lastname: Yu
mesh_terms: D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006801:Humans; D017063:Outcome Assessment, Health Care; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Chronic kidney disease; Meta-analysis; Outcome; Stroke; Systematic review; Tissue-type plasminogen activator