CKD does not indicate extra bleeding risks in stroke treatment

Chronic kidney disease (CKD) was not an indicator of increased bleeding risk in stroke patients treated with intravenous thrombolysis, according to a study published online Sept. 23 in Circulation: Cardiovascular Quality and Outcomes. The research team did note that stroke patients with CKD did have increased risks for poorer outcomes, however.

Bruce Ovbiagele, MD, MSc, MAS, of the Medical University of South Carolina in Charleston and colleagues compared the outcomes of stroke patients treated with intravenous tissue-type plasminogen activator to determine if CKD posed added risks for patients.

While patients with CKD are at increased risk in general for systemic bleeds and intracranial hemorrhage, they found that patients with CKD were not significantly more likely to experience either when risk was adjusted.

Pre-adjustment, however, patients with CKD had higher rates of serious systemic hemorrhage (1.2 percent vs 0.9 percent) and were more likely to have symptomatic intracranial hemorrhage (5.4 percent vs 4.2 percent).

CKD patients were more likely to have poor discharge functional status (risk ratio 1.13) and were more likely to die in the hospital (risk ratio 1.22) compared to patients with normal kidney function, regardless of adjustment.

Ovbiagele et al noted that in-hospital mortality was associated strongly with kidney impairment and progressively worse renal dysfunction increased risks.

However, they did not find that CKD made thrombolysis too risky for use in these stroke patients as long as clinicians remained aware of patients’ poorer health in treatment. They suggested that chronic inflammation, electrolyte imbalances, anemia and stress that come with CKD may pose more of a risk than coagulation and platelet function and that physicians should be aware.

“These results suggest that poor outcomes attributable to CKD may be because of other adverse conditions linked to CKD, and so presence of CKD alone should not necessarily be a contraindication to administration of IV tPA to eligible patients with ischemic stroke, particularly from a hemorrhagic risk standpoint,” wrote Ovbiagele et al.