Abstract W P54: Renal Impairment in African American Stroke Patients and the Risk of Symptomatic ICH With Systemic tPA

Abstract

Background: Uremia is a bleeding risk in chronic kidney disease (CKD) that has a higher prevalence among African Americans (AA). Recent studies in predominantly Caucasian populations showed that impaired renal function did not increase the risk of symptomatic intracranial hemorrhage (sICH) with intravenous tPA for acute ischemic stroke. We sought to determine if the risk of sICH is higher in AA patients with CKD at our institution. Subjects & Methods: Consecutive patients who received intravenous thrombolysis at our comprehensive stroke center were retrospectively analyzed. Demographics, stroke severity, and instances of sICH were recorded. Renal function was assessed by creatinine clearance (CrCl) and estimated with the Cockcroft and Gault equation. CKD was defined as CrCl < 60. CrCl was further stratified into the following groups: 59 - 30, 29 - 15, and < 15 ml/min. Results: We identified 236 patients with reported CrCl who received tPA at our institution (mean age 65+/-17 SD, 46% women, pre-treatment median NIHSS 5; IQR 8) and CKD was documented in 90/236 (38%) of all tPA-treated patients. AA patients comprised 36% (86/236) of the study population with 37 (43%) diagnosed with CKD, p=0.23 AA vs rest. Among all patients with CKD (n=90), 83% had CrCl between 59 - 30 ml/min, 9% had 29 - 15 ml/min and 8% had <15 ml/min CrCl range. sICH occurred in 2/90 (2.2%) of all patients with CKD (both in 30-59 ml/min group) compared to 4/146 (2.7%) without CKD (NS). sICH among AA patients with or without CKD was 2.7% and 2% respectively (NS). Conclusions: Our data are consistent with previous studies that severe renal impairment did not result in higher risk of sICH since the enzymatic activity of tPA may be limited by uremia. Although limited by relatively small numbers, our analysis did not show an increased sICH risk due to any renal impairment or AA race.