Risk factors for acute kidney injury and impact of earlier anticoagulation on renal function in patients with normotensive pulmonary embolism: a retrospective cohort study
Peiran Yang,
Xin Liu,
Yu Zhang,
Qin Luo,
Zhenguo Zhai,
Jun Wan,
Guohui Fan,
Dingyi Wang,
Yanshuang Lyu,
Xiaomao Xu,
Yinong Chen
Affiliations
Peiran Yang
Department of Physiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People`s Republic of China
Xin Liu
The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
Yu Zhang
1 Tianjin Women`s and Children`s Health Center, Tianjin, China
Qin Luo
School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
Zhenguo Zhai
Center of Respiratory Medicine, China-Japan Friendship Hospital; National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People`s Republic of China
Jun Wan
4 0000 0004 1937 1450grid.24515.37Division of Life ScienceThe Hong Kong University of Science and Technology Clear Water Bay Hong Kong China
Guohui Fan
Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
Dingyi Wang
Center of Respiratory Medicine, China-Japan Friendship Hospital; National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People`s Republic of China
Yanshuang Lyu
Department of Physiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People`s Republic of China
Xiaomao Xu
Department of Pulmonary and Critical Care Medicine, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, People`s Republic of China
Yinong Chen
Center of Respiratory Medicine, China-Japan Friendship Hospital; National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People`s Republic of China
Objective We aimed to investigate the risk factors for acute kidney injury (AKI) after normotensive pulmonary embolism (PE) and the impact of anticoagulation on renal recovery.Design Multicentred, retrospective cohort study.Setting Data from four tertiary hospitals in China were captured. All available measurements of serum creatinine (SCr) during hospitalisation and follow-up were collected.Participants Patients with acute PE and those without haemodynamic instability were enrolled. All recruited patients were followed up for up to 2 years.Primary and secondary outcome measures The primary outcome was the occurrence of AKI, defined by the Kidney Disease Improving Global Outcomes criteria. The secondary outcome was the recovery of renal function. The time interval between PE onset and the initiation of anticoagulation was analysed to obtain its influence on the recovery of renal function.Results A total of 461 patients with acute normotensive PE were enrolled. A transient elevation of SCr during hospitalisation was observed. The incidence of AKI among normotensive patients was 18.9%. Brain natriuretic peptide (BNP) NT-proBNP elevation (adjusted HR (aHR) 2.27, 95% CI 1.33 to 3.86) and history of chronic kidney disease (aHR 4.81, 95% CI 2.44 to 9.48) were associated with the development of AKI during hospitalisation. Earlier initiation of anticoagulation therapy (within 5 days after PE onset, compared with over 6 days) promoted an early recovery of renal function (adjusted OR 0.26, 95% CI 0.08 to 0.84, p=0.025).Conclusions Renal impairment and AKI were highly prevalent among patients with normotensive patients. The occurrence of AKI was associated with right heart function. Patients who developed AKI after PE would benefit from earlier anticoagulation therapy for an early recovery of renal function.
