The outcomes of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke among patients with reduced kidney function are uncertain. We conducted a retrospective cohort study between 2002-2013 to describe rt-PA use and the risk of secondary intracranial hemorrhage (ICH) and disability at discharge. In an overlap weighted cohort of rt-PA eligible patients (1,354), the relative risk (RR) of secondary ICH among those who received rt-PA (vs. no rt-PA) was 2.56 (99% confidence interval (CI) 1.77-3.69) in those with an estimated glomerular filtration rate (eGFR) ≥60, and 2.67 (2.17-6.20) in those with an eGFR 30-59 mL/min/1.73m2. Those treated with rt-PA were more likely to be discharged alive and independent compared no rt-PA (RR ≥60: 1.34 (1.17-1.53), 30-59: 1.53 (1.21-1.93) and, \u3c30/chronic dialysis: 2.13 (0.80-5.67)). rt-PA treated patients versus no rt-PA have a higher risk of bleeding but also have a greater chance of leaving hospital alive and independent
