Acute stroke thrombolysis in end-stage renal disease: a national survey of nephrologist opinion.

Background/aims: Systemic thrombolysis for acute ischaemic stroke is the standard of care in the UK. In the absence of trial data on the safety and efficacy of this treatment in patients with end-stage renal disease, we captured the views of UK nephrologists to highlight health care policy and research objectives.

Methods: Consultant nephrologists participated in an internet-based questionnaire. Respondents were asked about their involvement in thrombolysis decisions, safety concerns in dialysis patients, views on stroke rehabilitation and opinions on antiplatelet and warfarin use for stroke prevention.

Results: 122/433 (28%) clinicians responded. 75% wanted involvement in thrombolysis decisions although just 10% gave input in practice. 64% expressed a high degree of concern (≥7/10) regarding intracranial bleeding risk in haemodialysis (HD). Overall risks of intra- and extracranial bleeding were rated lower in peritoneal dialysis (PD; p < 0.001). 85% felt the HD schedule impacted negatively on rehabilitation, whereas 63% felt this was the case in the context of PD (p = 0.001). More clinicians favoured warfarin for stroke prevention in PD patients with atrial fibrillation in comparison with HD patients (79 vs. 66%, p = 0.04).

Conclusion: The majority of nephrologists want involvement in thrombolysis decisions relevant to their patients. Concerns about bleeding risks with thrombolysis are high and we identify a vital need to improve access to stroke rehabilitation in the UK, especially in HD patients.