Endovascular treatment in patients with renal dysfunction: results of the MR CLEAN Registry

Abstract

Introduction: It is unclear whether renal function is associated with outcome in patients with ischaemic stroke treated with EVT, as findings in existing literature have been inconsistent. We studied the association between renal function and outcomes in EVT-treated patients. Patients and methods: We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry. We assessed the association between renal function using estimated glomerular filtration rate (eGFR) and functional outcome measured with the mRS score, mortality and the occurrence of sICH in ischaemic stroke patients treated with EVT. We used ordinal regression modelling to estimate common odds ratios (cOR) per 10-unit decrease in eGFR, adjusted for known prognostic factors. Results: We analysed 4466 patients included between March 2014 and December 2018. Patients with lower eGFR were older, had more severe strokes at baseline, more comorbidities and higher pre-stroke mRS scores (all P < .001). In unadjusted analyses, higher eGFR was associated with better 3-month functional outcome (cOR 1.18; 95% CI, 1.15–1.21) and lower mortality (cOR 0.81; 95% CI, 0.78–0.83). After adjusting for demographic factors, only the association between eGFR and mortality remained significant. After further adjustment for medical history and comorbidities, no association was found between eGFR and mRS (adjusted odds ratio [aOR] 0.99; 95% CI, 0.96–1.02) or mortality (aOR 0.96; 95% CI, 0.93–1.01). There was no association between eGFR and sICH (cOR 0.95; 95%CI, 0.89–1.01, aOR 0.99; 95% CI, 0.93–1.06). Conclusion: Renal function was not an independent modifier of outcome after EVT for ischaemic stroke although eGFR may serve as a predictor of increased risk of disability and mortality. Based on these results, renal function alone should not determine eligibility for EVT in ischaemic stroke patients.