Abstract P551: Impact of Chronic Kidney Disease on Stroke Outcomes After Endovascular Thrombectomy - A Matched Cohort Study

Abstract

Objective: To determine the impact of chronic kidney disease (CKD) on stroke outcomes stratified by severity of renal impairment among acute ischemic strokes (AIS) patients treated with endovascular therapy (EVT). Methods: Single center retrospective analysis was conducted from January 2012 to December 2019 involving AIS patients with CKD undergoing EVT. We evaluated following primary safety and efficacy outcomes: inpatient mortality and reperfusion status according to TICI score, respectively. Our secondary safety outcomes were symptomatic intracranial hemorrhage (sICH) per SITS-MOST definition, whereas secondary efficacy outcomes were length of hospitalization and favorable discharge disposition (discharge to home or inpatient rehabilitation). CKD was defined with estimated glomerular filtration rate (eGFR) ranging from mild (eGFR 60-89 mL/ min) to moderate (eGFR 30-59 mL/min) to severe (eGFR 15-29 mL/min). We performed propensity score matching to eliminate confounding variables between CKD and non-CKD patients (1:2). In our subgroup analysis, we compared patients with mild-moderate CKD patients and severe CKD and evaluated their association with various clinical outcomes. Results: From a total of 466 AIS patients undergoing EVT, 84 CKD and 165 patients with normal renal function were selected based on 1:2 propensity score matching. CKD was associated with increased risk of in-hospital mortality (Odds ratio [OR] 2.58, 95% confidence interval [CI] 1.49-4.64, p <0.001), whereas favorable discharge disposition, length of hospitalization, sICH, TICI 2B/3 were comparable between the two groups. Subgroup analysis showed that patients with mild and moderate CKD were observed to have favorable discharge disposition (p=0.002), whereas patients with severe CKD were noted to have a higher risk of sICH ( p = 0.03) and prolonged hospitalization 11.54 ± 11.87 days (OR; 1.10, 95% CI 1.03-1.18, p = 0.006). Conclusion: History of CKD among AIS patients undergoing EVT were associated with a higher rate of inpatient mortality. In comparison to patients with mild and moderate CKD, patients with severe CKD were noted to have an increased risk of sICH, prolonged hospitalization, and poor discharge disposition.