Acute and Chronic Kidney Dysfunction and Prognosis following Thrombectomy for Ischemic Stroke

Abstract

<b><i>Introduction:</i></b> 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 <i>RISOTTO</i> 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. <b><i>Methods:</i></b> This multicenter cohort study included patients in the acute phase of ischemic stroke due to large artery occlusion managed by thrombectomy. Functional outcome at 3 months was assessed by the modified Rankin Scale (mRS). <b><i>Results:</i></b> 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%, <i>p</i> = 0.262) but higher mortality (24.2% versus 9.5%, <i>p</i> = 0.004). In univariate analysis, patients with CKD had a higher burden of white matter hyperintensities (Fazekas score: 1.7 ± 0.8 vs. 1.0 ± 0.8, <i>p</i> = 0.002), lower initial infarct volume with equivalent severity, and lower recanalization success (86.4% vs. 97.0%, <i>p</i> = 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%, <i>p</i> = 0.002) and mortality (23.4% versus 7.7%, <i>p</i> = 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], <i>p</i> = 0.029) and mortality (_adjOR 2.52 [1.03–6.18], <i>p</i> = 0.043) at 3 months, while CKD was not independently associated with 3-month mortality and poor neurological outcome. <b><i>Conclusions:</i></b> 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.