The impact of acute kidney injury on in-hospital mortality in acute ischemic stroke patients undergoing intravenous thrombolysis

PLoS One. 2017 Oct 17;12(10):e0185589. doi: 10.1371/journal.pone.0185589. eCollection 2017.

Abstract

Introduction: Acute kidney injury (AKI) increases the risk of death in acute ischemic stroke (AIS) patients. Intravenous thrombolytic therapy (iv. rt-PA) seems to be the most effective treatment for AIS patients. The effects of AKI on iv. rt-PA treated AIS cases is less studied. Our paper addresses this issue.

Methods: 45 consecutive stroke patients treated with iv. rt-PA (median age = 64 years; 29 male) and 59 age and sex matched controls not eligible for iv. rt-PA have been enrolled in our study. Subjects were followed-up until hospital release or death (median follow up time = 12 days).

Results: The prevalence of AKI did not differ between iv. rt-PA treated patients and controls (35.5% vs. 33.89%). In both groups, AKI was associated with increased in-hospital mortality: 50.0% vs. 3.4% p<0.0001 (in the rt-PA treated), and 45% vs. 30.7% (in controls). AKI iv. rt-PA treated patients had a significantly higher risk of in hospital mortality as compared to the no-AKI iv. rt-PA treated (HR = 15.2 (95%CI [1.87 to 124.24]; P = 0.011). In a Cox-multivariate model, the presence of AKI after iv. rt-PA remained a significant factor (HR = 8.354; p = 0.041) influencing the in-hospital mortality even after correction for other confounding factors. The independent predictors for AKI were: decreased eGFR baseline and elevated serum levels of uric acid at admission, (the model explained 60.2% of the AKI development).

Conclusions: The risk of AKI was increased in AIS patients. Thrombolysis itself did not increase the risk of AKI. In the iv. rt-PA patients, as compared to non-AKI, those which developed AKI had a higher rate of in-hospital mortality. The baseline eGFR and the serum uric acid at admission were independent predictors for AKI development in the iv. rt-PA treated AIS patients.

Publication types

  • Observational Study

MeSH terms

  • Acute Kidney Injury / complications
  • Acute Kidney Injury / drug therapy
  • Acute Kidney Injury / mortality*
  • Acute Kidney Injury / urine
  • Administration, Intravenous
  • Aged
  • Biomarkers / urine
  • Brain Ischemia / complications
  • Brain Ischemia / drug therapy
  • Brain Ischemia / mortality*
  • Brain Ischemia / urine
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Glomerular Filtration Rate
  • Hospital Mortality / trends*
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge / statistics & numerical data
  • Prospective Studies
  • Stroke / complications
  • Stroke / drug therapy
  • Stroke / mortality*
  • Stroke / urine
  • Survival Analysis
  • Thrombolytic Therapy / methods
  • Tissue Plasminogen Activator / therapeutic use*
  • Treatment Outcome
  • Uric Acid / urine

Substances

  • Biomarkers
  • Fibrinolytic Agents
  • Uric Acid
  • Tissue Plasminogen Activator

Grant support

This research project was funded by an internal grant from the University of Medicine and Pharmacy ‘‘Victor Babes’’ Timisoara, PIII-C2-PCFI-2015/2016, www.umft.ro. AS received the funding. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.