Frequency and prognostic impact of acute kidney injury in patients with acute pulmonary embolism. Data from the RIETE registry. (15th September 2019)

• Record Type: Journal Article
• Authors: Murgier, Martin; Bertoletti, Laurent; Darmon, Michael; Zeni, Fabrice; Valle, Reina; Del Toro, Jorge; Llamas, Pilar; Mazzolai, Lucia; Villalobos, Aurora; Monreal, Manuel
• Is Part Of: International journal of cardiology. Volume 291(2019)
• Page Start: 121
• Page End: 126
• Publication Date: 2019-09-15
• Subjects: AKI acute kidney injury -- CKD chronic kidney disease -- CKD-EPI Chronic Kidney Disease - Epidemiology Collaboration -- COPD Chronic obstructive pulmonary disease -- CrCl creatinine clearance -- CVP central venous pressure -- DOAC Direct oral anticoagulants -- DVT Deep vein thrombosis -- eGFR Estimated glomerular filtration rate -- ICD International Classification of Diseases -- KDIGO Kidney Disease: Improving Global Outcomes -- LMWH Low molecular weight heparin -- MDRD Modification of the Diet in Renal Disease -- PE pulmonary embolism -- RIETE Registro Informatizado de la Enfermedad TromboEmbolica -- SBP systolic blood pressure -- SCr serum creatinine -- s-PESI simplified pulmonary embolism severity index -- VKA Vitamin k antagonist -- VTE venous thromboembolism; Pulmonary embolism -- Acute kidney injury -- Bleeding -- Risk -- Biomarkers -- Mortality; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.04.083
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Rationale: Acute kidney injury (AKI) is associated with a poor outcome. Although pulmonary embolism (PE) may promote AKI through renal congestion and/or hemodynamic instability, its frequency and influence on outcome in patients with acute PE have been poorly studied. Methods: The frequency of AKI (defined according to the "Kidney Disease: Improving Global Outcomes" definition) at baseline and its influence on the 30-day mortality was evaluated in patients with acute PE from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. We used multivariate analysis to assess whether the presence of AKI influenced the risk for 30-day death. Results: The study included 21, 131 patients, of whom 6222 (29.5%) had AKI at baseline: 4385 patients (21%) in stage 1, 1385 (6.5%) in stage 2 and 452 (2%) in stage 3. The proportion of patients with high-risk PE in those with no AKI, AKI stage 1, AKI stage 2 or AKI stage 3 was: 2.8%, 5.3%, 8.8% and 12%, respectively (p < 0.001). After 30 days, 1236 patients (5.9%) died. Overall mortality was 4% in patients with no AKI, 8.4% in AKI stage 1, 14% in AKI stage 2 and 17% in AKI stage 3 (all p < 0.001). AKI was independently associated with an increased risk of all-cause death at 30 days (odds ratio = 1.25; 95%CI: 1.02–1.54). Conclusions: One in every 3–4 patients with acute PE had AKI at baseline. The presence of AKI independently predicted 30-day mortality. This study suggests that AKI may deserve to be evaluated as a prognostic factor in patients with acute PE. Highlights: Acute pulmonary embolism (PE) may affect kidneys due to haemodynamic alterations. Acute kidney injury (AKI) is an established risk factor for fatal outcome. Its frequency and influence on outcome in patients with acute PE have been poorly studied. AKI independently predicted 30-day mortality in patients with acute PE. AKI is a potential prognostic factor in patients with acute PE.