XINWEN REN ¹ Chen Chen ^1,2,3 William Yang Zhao ^1,2 Qiang Li ² Xia Wang ² Shoujiang You ⁴ Menglu Ouyang ^1,2 Thompson Robinson ⁵ Richard Lindley ^2,6 Hisatomi Arima ^2,7 Xiaoying Chen ² John Chalmers ² Craig S Anderson ^1,2,8* Lili Song ^1,2*

• ¹ George Institute for Global Health, Beijing, China
• ² George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
• ³ Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
• ⁴ Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
• ⁵ NIHR Leicester Respiratory Biomedical Research Unit, Leicester, United Kingdom
• ⁶ The University of Sydney, Darlington, New South Wales, Australia
• ⁷ Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Fukushima, Japan
• ⁸ Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Santiago Metropolitan Region (RM), Chile

Background: The effect of renal impairment in patients who receive intravenous thrombolysis for acute ischemic stroke (AIS) is unclear. We aimed to determine associations of renal impairment and clinical outcomes and any modification of the effect of intensive versus guideline-recommended blood pressure (BP) control in the BP-arm of the international Enhanced Control of hypertension and Thrombolysis Stroke Study (ENCHANTED).Methods: Post-hoc analysis of the ENCHANTED BP-arm which involved 2196 thrombolyzed AIS patients. Logistic regression models were used to define association between eGFR and clinical outcomes of death, death or major disability (modified Rankin scale [mRS] scores 3-6) and major disability (mRS 3-5) at 90 days.Results: Of 2151 patients with available baseline renal function data (mean age 66.9 years; 38% female), 993 (46.2%), 822 (38.2%), and 336 (15.6%) had normal (eGFR ≥90 mL/min/1.73 m 2 ), mildly (60-89) and moderate-to-severely impaired (<60) renal function, respectively. Compared with patients with normal eGFR, mortality was higher in those with moderate-to-severe renal impairment (adjusted odds ratio 1.77, 95% confidence interval 1.05-2.99; p = .031 for trend). However, the difference in death or major disability (mRS 3-6) was not significant between groups. There was no heterogeneity in the treatment effect of intensive versus guideline-recommended BP lowering on death by grades of renal function (p for interaction = .545).Discussion: The presence of moderate-to-severe renal impairment is associated with increased mortality in thrombolyzed patients with AIS. Renal function does not modify the effect of early intensive BP-lowering treatment on death in this patient group.