Supplementary Material for: Acute and chronic kidney dysfunction and prognosis following thrombectomy for ischemic stroke

Introduction. Patients with Chronic Kidney Disease (CKD) have an increased risk of stroke and CKD seems associated with worse outcome after a stroke. The main objective of our study RISOTTO was to evaluate the influence of CKD and Acute Kidney Injury (AKI) on the clinical outcome and mortality of ischemic stroke patients after thrombolysis and/or thrombectomy.
Methods. This multicenter cohort study included patients in the acute phase of ischemic stroke due to a large artery occlusion managed by thrombectomy. Functional outcome at 3 months was assessed by modified Rankin Scale (mRS).
Results. 280 patients were included in the analysis. Fifty-nine patients (22.6%) had CKD. At 3 months, CKD was associated with similar functional prognosis (mRS 3-6: 50.0% vs. 41.7%, p=0.262) but higher mortality: 24.2% vs. 9.5%, p=0.004. In univariate analysis, patients with CKD had a higher burden of white matter hyperintensities (Fazekas 1.7±0.8 vs. 1.0±0.8, p=0.002), lower initial infarcted volume with equivalent severity, and lower recanalization success (86.4% vs. 97.0%, p=0.008) compared to non-CKD patients. Forty-seven patients (20.0%) developed AKI. AKI was associated with poorer 3-month functional outcome (mRS 3-6: 63.8% vs. 49.0%, p=0.002) and mortality: 23.4% vs. 7.7%, p=0.002. In multivariate analysis, AKI appeared as an independent risk factor for poor functional outcome (mRS 3-6: adjOR 2.79 [1.11-7.02], p=0.029) and mortality: adjOR 2.52 [1.03-6.18], p=0.043 at 3 months, while CKD was not independently associated with 3-month mortality and poor neurological outcome.
Conclusion. AKI is independently associated with poorer functional outcome and increased mortality at 3 months. CKD was not an independent risk factor for 3-month mortality or poor functional prognosis.

引言：慢性肾脏病（Chronic Kidney Disease, CKD）患者发生卒中的风险升高，且CKD似乎与卒中后不良预后相关。本研究RISOTTO的主要目的为评估CKD与急性肾损伤（Acute Kidney Injury, AKI）对接受溶栓和/或取栓治疗的缺血性卒中患者临床结局及死亡率的影响。
方法：本项多中心队列研究纳入了因大血管闭塞导致缺血性卒中、接受取栓治疗的急性期患者。采用改良Rankin量表（modified Rankin Scale, mRS）评估患者发病3个月时的功能结局。
结果：本分析共纳入280例患者。其中59例（22.6%）合并CKD。发病3个月时，CKD患者的功能预后与非CKD患者相似（改良Rankin量表评分3~6分占比：50.0% vs 41.7%，p=0.262），但死亡率更高（24.2% vs 9.5%，p=0.004）。单因素分析显示，与非CKD患者相比，CKD患者的脑白质高信号负荷更高（Fazekas评分：1.7±0.8 vs 1.0±0.8，p=0.002），初始梗死体积更小但病情严重程度相当，且再通成功率更低（86.4% vs 97.0%，p=0.008）。共有47例患者（20.0%）发生AKI。AKI与较差的3个月功能结局相关（改良Rankin量表评分3~6分占比：63.8% vs 49.0%，p=0.002），且死亡率更高（23.4% vs 7.7%，p=0.002）。多因素分析显示，AKI是3个月不良功能预后（校正比值比[adjusted odds ratio, adjOR] 2.79[1.11~7.02]，p=0.029）和死亡率（adjOR 2.52[1.03~6.18]，p=0.043）的独立危险因素，而CKD与3个月死亡率及不良神经功能预后无独立相关性。
结论：AKI是3个月时不良功能预后及死亡率升高的独立危险因素。CKD并非3个月死亡率或不良功能预后的独立危险因素。