Prognostic Impact of Estimated Acute Kidney Injury Compared with Estimated Glomerular Filtration in Patients with Acute Pulmonary Embolism: Data from CURES

Abstract

Background Renal function affects outcomes of acute pulmonary embolism (PE). We aimed to find an optimal method of renal function assessment for acute PE patients, by comparing the prognosis value of estimated acute kidney injury (AKI) and estimated glomerular filtration rate (eGFR) on hospitalized PE patients. Methods Adult patients diagnosed acute PE from 2009 to 2015 with available data of serum creatine (SCr) were enrolled from a nationwide, multicenter registry in China (CURES registry). Patients with high-risk PE were excluded. eGFR was calculated by MDRD equation. Estimated AKI was defined according to the “Kidney Disease: Improving Global Outcomes” (KDIGO) definition, by using the single assessment of SCr at admission. All-cause death, PE-related death, and bleeding events during hospitalization were analyzed as endpoints. Results A total of 3,575 patients with acute normotensive PE patients were enrolled into analysis. 253 (7.1%) patients were identified estimated AKI at admission and moderate-to- severe renal insufficiency (eGFR < 60ml/min·1.73m²) was identified in 406 (12.0%) patients. The overlaps of different stages of estimated AKI and levels of eGFR showed that all patients with estimated AKI meet the definition of moderate-to-severe renal insufficiency. Patients met both estimated AKI and eGFR < 60ml/min·1.73m² had higher rates of in-hospital mortality and PE-related death than those with only eGFR < 60ml/min·1.73m² (4.7% vs 0.7% and 2.4% vs 0, respectively, both p < 0.05). The rates of any bleeding and major bleeding were significantly higher in those had eGFR < 60ml/min·1.73m² than eGFR ≥ 60ml/min·1.73m² (9.2% vs 5.6% and 4.5% vs 1.5%, respectively, both p < 0.05). Conclusion The presence of AKI was more associated with short-term mortality while impaired eGFR was related to an increased incidence of bleeding events. Proper assessment of kidney function and individualized decision-making in patients with acute PE are important.