{"id":24576,"date":"2026-10-01T09:28:21","date_gmt":"2026-10-01T13:28:21","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=24576"},"modified":"2026-10-02T09:33:16","modified_gmt":"2026-10-02T13:33:16","slug":"intravenous-thrombolysis-for-acute-ischemic-stroke-across-kidney-function","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/intravenous-thrombolysis-for-acute-ischemic-stroke-across-kidney-function\/","title":{"rendered":"Intravenous thrombolysis for acute ischemic stroke across kidney function"},"content":{"rendered":"<p><strong>Background<\/strong> \u2014 The effectiveness and safety of recombinant tissue-plasminogen activator (rt-PA; alteplase) for acute ischemic stroke in patients with low estimated glomerular filtration rate (eGFR) are uncertain. We evaluated whether the risks and benefits of rt-PA versus no rt-PA vary by eGFR category.<\/p>\n<p><strong>Methods<\/strong> \u2014 We conducted a population-based cohort study of 4\u2009632 rt-PA\u2013eligible adults with acute ischemic stroke and a recorded eGFR in Ontario, Canada (2002\u20132013). Propensity score overlap weighting was used to balance treated and untreated patients. Primary outcomes were transformation to intracranial hemorrhage (ICH) and functional independence at hospital discharge. Secondary outcomes were in-hospital and one-year mortality. Analyses were stratified by eGFR category (mL\/min per 1.73 m2): \u226560, 30\u201359, and &lt; 30 or receiving maintenance dialysis.<\/p>\n<p><strong>Results<\/strong> \u2014 After weighting, 1\u2009354 patients were included. For eGFR \u2265 60, ICH occurred in 58\/402 (14.4%) with rt-PA and 23\/402 (5.7%) without rt-PA; weighted relative risk (RRw) 2.56 (99% CI, 1.77\u20133.69). For eGFR 30\u201359, ICH was 36\/246 (14.6%) vs. 10\/246 (4.0%); RRw 3.67 (99% CI, 2.17\u20136.20). For eGFR &lt; 30 or maintenance dialysis, event counts were small, preventing reliable estimation. rt-PA was associated with greater discharge independence across all eGFR categories. In-hospital mortality did not differ by treatment within eGFR categories. One-year mortality was lower with rt-PA for eGFR \u2265 60, with comparable point estimates for eGFR 30\u201359 and &lt; 30 or maintenance dialysis.<\/p>\n<p><strong>Conclusions<\/strong> \u2014 In patients with low kidney function, rt-PA increases ICH risk but improves functional outcomes. The balance of risks and benefits appears broadly consistent across eGFR categories.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background \u2014 The effectiveness and safety of recombinant tissue-plasminogen activator (rt-PA; alteplase) for acute ischemic stroke in patients with low estimated glomerular filtration rate (eGFR) are uncertain. We evaluated whether the risks and benefits of rt-PA versus no rt-PA vary by eGFR category. Methods \u2014 We conducted a population-based cohort study of 4\u2009632 rt-PA\u2013eligible adults [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[41,40,49,56],"migration-helper-qa-sample-set":[],"class_list":["post-24576","journal_article","type-journal_article","status-publish","hentry","topic-brain-diseases","topic-cardiovascular-disease","topic-kidney-disease","topic-pharmacoepidemiology-and-drug-safety"],"acf":{"citation":"Bota SE, Dixon S, Kapral MK, Hackam D, Sood MM, Sontrop JM, Garg AX. <em>Nephrol Dial Transplant<\/em>. 2026; Oct 1 [Epub ahead of print].","source_url":"https:\/\/doi.org\/10.1093\/ndt\/gfag222","ices_scientist":[1208,1150,1242],"site":[6739],"research_program":[6747],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Intravenous thrombolysis for acute ischemic stroke across kidney function<\/title>\n<meta name=\"description\" content=\"Background \u2014 The effectiveness and safety of recombinant tissue-plasminogen activator (rt-PA; 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