Favorable Renal Outcomes after Intravenous Thrombolytic Therapy for Acute Ischemic Stroke: Clinical Implication of Kidney-Brain axis. 

Chang TH¹， Chiu PF^{1，2，3，4，} Tsai CC¹， Chang CH¹， Wu CL¹， Kor CT⁵， Li JR⁵， Kuo CL⁴， Huang CS⁴， Chu CC⁶， Lin CM^7，8，9， Chang CC^{1，2，4，10，11}.

Abstract
AIM:
Recombinant tissue plasminogen activator (rt-PA) administration is the most prevalent treatment for acute ischemic within golden time. However， the effects of rt-PA on the kidney function in such patients remain unknown. This study determined long-term renal outcomes in patients with acute ischemic stroke receiving systemic rt-PA.
METHODS:
We enroled patients who were hospitalized for acute ischemic stroke from January 2001 to January 2017. We applied 1:2 propensity score matching to eliminate various confounding variables. We defined surrogate renal outcomes as declining of estimated glomerular filtration rate (eGFR) greater than 30% and 50%， and chronic kidney disease (CKD) with eGFR less than 60 mL/min. We then compared the 1-year eGFR with paired t-test in patients treated with or without rt-PA.
RESULTS:
Overall， 343 of 1739 patients received rt-PA within golden time. After 1:2 propensity score matching， their baseline characteristics were grouped as treated with rt-PA (n = 235) or not (n = 394). rt-PA-treated patients exhibited slower renal progression， including the risk of eGFR declining greater than 30% (hazard ratio (HR)， 0.72; P = 0.03)， risk of declining eGFR greater than 50% (HR， 0.63; P = 0.046) and risk of CKD (HR， 0.61; P = 0.005). After 1-year cohort， the rt-PA group exhibited an improved renal outcome by the paired t-test (propensity match: ΔGFR = 9.1 (95% confidence interval: 6.3， 11.8)， P < 0.001 in rt-PA group; ΔGFR = -1.1 (95% confidence interval: -2.9， 0.7)， P = 0.23 in non-rt-PA group). In patients with eGFR less than 45 mL/min (n = 34)， intracerebral haemorrhage was not reported.
CONCLUSION:
Patients receiving rt-PA for acute ischemic stroke exhibit favourable renal outcomes， and no increased incidence of intracerebral haemorrhage occurs in rt-PA patients with advanced CKD.

資料來源:Nephrology (Carlton). 2018 Oct 17. doi: 10.1111/nep.13516.