Division of Neurology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan.
J Stroke Cerebrovasc Dis. 2011 Mar-Apr;20(2):111-6. doi: 10.1016/j.jstrokecerebrovasdis.2009.11.008. Epub 2010 Jun 26.
The oxygen free radical scavenger edaravone is used in patients with acute ischemic stroke in Japan, but adverse reactions, especially decreased renal function, have raised concerns. To examine whether a patient's estimated glomerular filtration rate (eGFR) at admission can predict renal function deterioration after edaravone treatment, we retrospectively evaluated the effect of edaravone on eGFR in Japanese patients with acute ischemic stroke and chronic kidney disease (CKD). The baseline eGFR in the edaravone-treated group (73.5±20.3 mL/min/1.73 m(2); n=408) at admission was significantly (P < .05) higher than that in the non-edaravone-treated group (51.9±25.2 mL/min/1.73 m(2); n=41). The change in eGFR after treatment was categorized into 3 grades: nonexacerbation (≤10%), 10%-30% exacerbation, and >30% exacerbation. There was no significant difference in exacerbation grade between the edaravone-treated and non-edaravone-treated groups (χ(2) =3.134; P=.21). We next subdivided the edaravone-treated group according to eGFR at admission as either CKD (eGFR <60 mL/min/1.73 m(2); n=111) and non-CKD (n=297). No significant decrease in eGFR was seen even in the edaravone-treated CKD group (most of whom were in stage 3 CKD). Decreased eGFR in stroke patients was found to be associated with stroke subtype (cardiogenic stroke), but not with infection. The present study demonstrates that eGFR at admission is not a good predictor of renal deterioration in edavarone-treated acute ischemic stroke patients, including those with stage 3 CKD.
依达拉奉是一种用于治疗日本急性缺血性脑卒中患者的氧自由基清除剂，但因其不良反应，特别是肾功能下降，引起了人们的关注。为了研究患者入院时的估算肾小球滤过率（eGFR）是否可以预测依达拉奉治疗后肾功能的恶化情况，我们回顾性评估了依达拉奉对伴有慢性肾脏病（CKD）的日本急性缺血性脑卒中患者的 eGFR 的影响。依达拉奉治疗组（73.5±20.3 mL/min/1.73 m2；n=408）的入院时 eGFR 明显（P<.05）高于未使用依达拉奉治疗组（51.9±25.2 mL/min/1.73 m2；n=41）。治疗后 eGFR 的变化分为 3 个等级：无恶化（≤10%）、恶化 10%-30%、恶化>30%。依达拉奉治疗组和未使用依达拉奉治疗组的恶化等级之间无显著差异（χ2=3.134；P=.21）。接下来，我们根据入院时的 eGFR 将依达拉奉治疗组进一步分为 CKD（eGFR<60 mL/min/1.73 m2；n=111）和非 CKD（n=297）组。即使在依达拉奉治疗的 CKD 组（大多数患者处于 CKD 3 期）中，eGFR 也没有明显下降。研究发现，脑卒中患者 eGFR 的降低与脑卒中亚型（心源性脑卒中）有关，而与感染无关。本研究表明，入院时的 eGFR 不能很好地预测依达拉奉治疗的急性缺血性脑卒中患者，包括 CKD 3 期患者的肾功能恶化情况。
