Can eGFR be a prognostic factor for endovascular therapy for acute ischemic stroke?

Abstract

Background & Objective: Chronic kidney disease (CKD) is associated with increased mortality risk in acute stroke patients. This study aims to investigate potential association between CKD and the prognosis of endovascular treated acute ischemic stroke patients.

Methods: Patients with endovascular treatment (EVT) for acute ischemic stroke were studied retrospectively in a comprehensive stroke center. Patients were classified as pre-procedural CKD and non-CKD. The groups were compared regarding demographic data, procedural data, and outcomes.

Results: A total of 140 patients (69 male, 49.3%) with a mean age of 66.51±11.8 were involved in the study. Symptomatic intracranial hemorrhage in the first 24 hours and mortality in three months were increased in the CKD group (50% vs. 19.8; p=0.001). Excellent and good outcomes were decreased in the CKD group (25% vs. 53.4; p=0.01 and 41.6% vs. 56.9%; p=0.03). Multiple logistic regression adjusted for potential confounders demonstrated that CKD was associated with lower rates of excellent outcome (odds ratio [OR] = 0.50, 95% confidence interval [CI], 0.25 to 0.80, p = 0.01), higher mRS scores (common OR = 1.82, 95% CI, 1.2 to 2.9, p = 0.01), and increased mortality (OR = 2.1, 95% CI, 1.2 to 4.2, p = 0.01) and sICH (OR = 1.15, 95% CI, 1.03 to 3.4, P = 0.04)

Conclusion: There is an association between CKD and poorer results in patients with acute ischemic stroke treated with EVT. The presence of CKD should not prohibit patients from undergoing EVT, but taking baseline eGFR into account may improve estimation of prognosis and help decision-making in treatment modality.