Data from: Intravenous thrombolysis in patients with chronic kidney disease: A systematic review and meta-analysis

Objective We sought to determine the association of chronic kidney disease (CKD) with the safety and efficacy of intravenous thrombolysis (IVT) among acute ischemic stroke (AIS) patients. Methods Systematic review and pairwise meta-analysis of studies involving patients with CKD undergoing IVT for AIS were conducted to evaluate the following outcomes: symptomatic intracranial hemorrhage (sICH), asymptomatic and any ICH, in-hospital and 3-month mortality, 3-month favorable functional outcome (FFO, mRS 0-1) and 3-month functional independence (FI, mRS 0-2). CKD was defined using estimated glomerular filtration rate (eGFR) ranging from mild (eGFR: 60-89ml/min), moderate (eGFR: 30-59ml/min) and severe (eGFR: 15-29ml/min). Results We identified 20 studies comprising 60,486 AIS patients treated with IVT. In unadjusted analyses, CKD was associated with sICH according to NINDS (7 studies; OR=1.41, 95%CI: 1.19–1.67) and ECASS-II (9 studies; OR=1.37, 95%CI: 1.01–1.85) definitions, any ICH (8 studies; OR=1.42, 95%CI: 1.18–1.70), 3-month mortality (9 studies; OR = 2.20, 95%CI: 1.72–2.81), 3-month FFO (8 studies; OR=0.58, 95%CI: 0.47–0.72) and 3-month FI (8 studies; OR=0.57, 95%CI: 0.46–0.71). In adjusted analyses, CKD was associated with sICH according to NINDS (4 studies; ORadj=1.34, 95%CI: 1.01–1.79) and ECASS-II (3 studies; ORadj=2.08, 95%CI 1.27–3.43) definitions, any ICH (6 studies; ORadj=1.41, 95%CI 1.01–1.97), in-hospital mortality (2 studies; ORadj =1.19; 95%CI, 1.09-1.30) and 3-month FFO (6 studies; ORadj=0.80, 95%CI 0.70–0.92). Conclusions After adjustment for confounders in this pairwise meta-analysis, moderate-severe CKD is associated with increased risks of intracranial hemorrhage and worse functional outcomes among AIS patients treated with IVT.

**研究目的** 本研究旨在明确急性缺血性卒中（acute ischemic stroke, AIS）患者合并慢性肾脏病（chronic kidney disease, CKD）与静脉溶栓（intravenous thrombolysis, IVT）治疗的安全性及有效性之间的关联。**研究方法** 本研究针对接受静脉溶栓（intravenous thrombolysis, IVT）治疗的急性缺血性卒中（acute ischemic stroke, AIS）且合并慢性肾脏病（chronic kidney disease, CKD）的患者相关研究，开展系统评价与配对meta分析，以评估以下结局指标：症状性颅内出血（symptomatic intracranial hemorrhage, sICH）、无症状性颅内出血及任何类型颅内出血（intracranial hemorrhage, ICH）、院内死亡率与3个月死亡率、3个月良好功能结局（favorable functional outcome, FFO，mRS 0-1）及3个月功能独立（functional independence, FI，mRS 0-2）。慢性肾脏病（CKD）依据估算肾小球滤过率（estimated glomerular filtration rate, eGFR）进行分期：轻度（eGFR：60~89ml/min）、中度（eGFR：30~59ml/min）及重度（eGFR：15~29ml/min）。**研究结果** 本研究共纳入20项研究，涉及60486例接受静脉溶栓（IVT）治疗的急性缺血性卒中（AIS）患者。未校正混杂因素的分析显示，依据美国国立神经疾病与卒中研究院（NINDS）制定的定义（7项研究；比值比OR=1.41，95%置信区间CI：1.19~1.67）及欧洲急性卒中协作组Ⅱ（ECASS-II）制定的定义（9项研究；OR=1.37，95%CI：1.01~1.85），慢性肾脏病（CKD）均与症状性颅内出血（sICH）相关；同时慢性肾脏病（CKD）与任何类型颅内出血（ICH）（8项研究；OR=1.42，95%CI：1.18~1.70）、3个月死亡率（9项研究；OR=2.20，95%CI：1.72~2.81）、3个月良好功能结局（FFO，mRS 0-1）（8项研究；OR=0.58，95%CI：0.47~0.72）及3个月功能独立（FI，mRS 0-2）（8项研究；OR=0.57，95%CI：0.46~0.71）存在显著关联。校正混杂因素后的分析显示，依据NINDS定义（4项研究；校正后比值比ORadj=1.34，95%CI：1.01~1.79）及ECASS-II定义（3项研究；ORadj=2.08，95%CI：1.27~3.43），慢性肾脏病（CKD）仍与症状性颅内出血（sICH）相关；此外慢性肾脏病（CKD）与任何类型颅内出血（ICH）（6项研究；ORadj=1.41，95%CI：1.01~1.97）、院内死亡率（2项研究；ORadj=1.19；95%CI：1.09~1.30）及3个月良好功能结局（FFO，mRS 0-1）（6项研究；ORadj=0.80，95%CI：0.70~0.92）存在显著关联。**研究结论** 本配对meta分析经混杂因素校正后显示，中重度慢性肾脏病（CKD）与接受静脉溶栓（IVT）治疗的急性缺血性卒中（AIS）患者颅内出血风险升高及功能结局更差显著相关。