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Abstract Details

Influence of renal impairment on hemorrhagic transformation and outcome in stroke patients undergoing reperfusion therapy: a systematic review and meta-analysis
Cerebrovascular Disease and Interventional Neurology
P8 - Poster Session 8 (8:00 AM-9:00 AM)
4-010
To investigate whether renal impairment has an influence on hemorrhagic transformation and outcome in stroke patients undergoing reperfusion intravenous alteplase (IVT) or mechanical thrombectomy (MT).

The association between renal impairment and hemorrhagic transformation or outcome in patients receiving reperfusion therapy (IVT or MT) remains unclear.

We systematically searched PubMed and Ovid EMBASE for potentially eligible studies that evaluated renal impairment at baseline with subsequent follow-up for outcome in stroke patients receiving IVT or MT. Renal impairment was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. The primary outcomes were symptomatic intracerebral hemorrhage (sICH), mortality at 3 months and poor outcome (defined as modified Rankin Scale [mRS]) at 3 months.

Fourteen studies were included (N=56696).  The pooled crude estimates suggested that renal impairment was significantly associated with sICH based on National Institute of Neurological Disorders and Stroke (odds ratio [OR], 1.39, 95% confidence intervals [CI] 1.12-1.73), mortality at 3 months (OR 2.79, 95%CI 2.29-3.40), and poor outcome at 3 months (mRS 2-6 OR, 2.02, 95%CI 1.70-2.39; mRS 3-6 OR 2.06, 95%CI 1.48-2.87). Similar results were found in our pooled adjusted results between renal impairment and sICH based on the European Cooperative Acute Stroke Study II criteria (OR 2.00, 95%CI 1.47-2.76), mortality at 3 months (OR 2.00, 95%CI 1.47-2.76), and poor outcome at 3 months (mRS 3-6 OR 1.32, 95%CI 1.10-1.58). In subgroup analyses among patients with renal impairment after receiving IVT, heterogeneity was significant in patients<70 years old compared with those≥70 years old (2.04, 1.71-2.43 vs 3.03, 2.63-3.49; P<0.001) regarding mortality at 3 months, and in Asians compared with Non-Asians (1.09, 0.79-1.50 vs. 2.09, 1.85-2.35, P<0.001).

Ischemic stroke patients with renal impairment may be associated with increased risks of sICH, mortality and poor outcome after thrombolysis. Further studies are needed to explore these issues in patients receiving thrombectomy.
Authors/Disclosures
Yanan Wang
PRESENTER 		No disclosure on file
Yajun Cheng No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file