Ulyanovsk Medico-biological Journal

CLINICAL MEDICINE

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DOI 10.34014/2227-1848-2021-2-36-45

ACUTE KIDNEY INJURY IN PATIENTS WITH PULMONARY ARTERY THROMBOEMBOLIA

V.V. Filimonova, M.V. Menzorov, A.Yu. Bol'shakova

Ulyanovsk State University, Ulyanovsk, Russia

 

The aim of the study is to diagnose acute kidney injury, its severity, and types in patients with pulmonary artery thromboembolia (PATE), to establish the correlation between AKI and the estimated mortality risk, hospital mortality.

Materials and Methods. The study enrolled 111 patients (61 males (55 %), and 50 females (45 %), average age 66.8±11.7 years) with PATE, hospitalized to the cardiology department of Ulyanovsk Central City Clinical Hospital.

Results. Acute kidney injury was diagnosed in 36 patients with PATE (34 %): among them 24 patients with stage 1 PATE (67 %); 7 patients with stage 2 (19 %); 5 patients with stage 3 (14 %). Prehospital complications were diagnosed in 20 patients (56 %), hospital AKI was detected in 16 patients (44 %). CKD-associated AKI was observed in 24 patients (67 %), de novo AKI was diagnosed in 12 trial subjects (33 %). Twenty-six patients (23 %) died during hospitalization. The relative hospital mortality risk in AKI patients was 5.2 (95 % CI: 2.02–13.39; p<0.001). The estimated risk of 30-day mortality according to the PESI score was higher in AKI patients (120.0 (87.5–158,0) and 90 (87.5–158.0), respectively, p=0.004).

Conclusion. Patients with PATE had a high incidence of AKI, which was diagnosed in every 3rd patient. In 67 % of patients, AKI was associated with chronic kidney disease. Patients with prehospital AKI prevailed (56 %). AKI in patients with PATE was associated with increased in-hospital mortality and an estimated 30-day mortality risk.

Keywords: acute kidney injury, pulmonary embolism, hospital mortality, estimated mortality risk.

Conflict of interest. The authors declare no conflict of interest.

 

References

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  2. Menzorov M.V., Shutov A.M., Makeeva E.R., Strakhov A.A. Ostroe povrezhdenie pochek u bol'nykh s ostroy dekompensatsiey khronicheskoy serdechnoy nedostatochnosti [Acute kidney injury in patients with acute decompensation of chronic heart failure]. Klinitsist. 2013; 2: 29–33 (in Russian).

  3. Lewington A.J., Cerdá J., Mehta R.L. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013; 84 (3): 457–467.

  4. Chertow G.M., Burdick E., Honour M. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J. Am. Soc. Nephrol. 2005; 16: 3365–3370.

  5. Yang C.H., Chang C.H., Chen T.H. Combination of urinary biomarkers improves early detection of acute kidney injury in patients with heart failure. Circ. J. 2016; 80: 1017–1023.

  6. Abbott K.C., Cruess D.F., Agodoa L.Y., Sawyers E.S., Tveit D.P. Early renal insufficiency and late venous thromboembolism after renal transplantation in the United States. Am. J. Kidney Dis. 2004; 43: 120–130.

  7. Tveit D.P., Hypolite I.O., Hshieh P., Cruess D., Agodoa L.Y., Welch P.G. Chronic dialysis patients have high risk for pulmonary embolism. Am. J. Kidney Dis. 2002; 39: 1011–1017.

  8. Anderson F.A.Jr., Spencer F.A. Risk factors for venous thromboembolism. Circulation. 2003; 107: 9–16.

  9. Boettger B., Wehling M., Bauersachs R.M. Initial anticoagulation therapy in patients with venous thromboembolism and impaired renal function: results of an observational study. J. Public Health. 2014; 22: 89–99.

  10. Chang C.H., Fu C.M., Fan P.C., Chen S.W., Chang S.W., Mao C.T., Tian Y.C., Chen Y.C., Chu P.H., Chen T.H. Acute kidney injury in patients with pulmonary embolism: A population-based cohort study. Medicine (Baltimore). 2017; 96 (9): e5822.

  11. Martin Murgier, Laurent Bertoletti, Michael Darmon, FabriceZeni, Reina Valle, Jorge Del Toro, Pilar Llamas, Lucia Mazzolai, Aurora Villalobos, Manuel Monreal, RIETE Investigators. Frequency and Prognostic Impact of Acute Kidney Injury in Patients with Acute Pulmonary Embolism. Data from the RIETE Registry. Int. J. Cardiol. 2019; 291: 121–126.

  12. Trimaille A., Marchandot B., Girardey M., Muller C., Lim H.S., Trinh A., Ohlmann P., Moulin B., Jesel L., Morel O. Assessment of Renal Dysfunction Improves the Simplified Pulmonary Embolism Severity Index (sPESI) for Risk Stratification in Patients with Acute Pulmonary Embolism. J. Clin. Med. 2019; 8 (2): 160–174.

  13. Kostrubiec M., Pruszеzyk P., Bochowicz A. Biomarker-based risk assessment model in acute pulmonary embolism. Eur. Heart J. 2005; 26: 2166–2172.

  14. ESC Guideline on the diagnosis and management of acute Pulmonary Embolism. European Heart Journal. 2014; 35: 3033–3080.

  15. ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society. European Heart Journal. 2020; 41: 543–603.

  16. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. Kidney inter. Suppl. 2012; 2 (6): 1–138.

  17. Wilke T., Wehling M., Amann S., Bauersachs R.M., Böttger B. Renal impairment in patients with thromboembolic event: prevalence and clinical implications. A systematic review of the literature. Dtsch. Med. Wochenschr. 2015; 140 (17): 166–174.

Received 09 February 2021; accepted 10 April 2021.

 

Information about the authors

Filimonova Valentina Vyacheslavovna, Post-graduate Student, Chair of Therapy and Occupational Diseases, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy St., 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-1293-4014

Menzorov Maksim Vital'evich, Doctor of Sciences (Medicine), Professor, Chair of Therapy and Occupational Diseases, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy St., 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-6000-4850

Bol'shakova Anna Yur'evna, Resident, Chair of Therapy and Occupational Diseases, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy St., 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-0974-5407

 

For citation

Filimonova V.V., Menzorov M.V., Bol'shakova A.Yu. Ostroe povrezhdenie pochek u patsientov s tromboemboliey legochnoy arterii [Acute kidney injury in patients with pulmonary artery thromboembolia]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2021; 2: 36–45. DOI: 10.34014/2227-1848-2021-2-36-45 (in Russian).

 

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УДК 616.61-008.64-07-08

DOI 10.34014/2227-1848-2021-2-36-45

ОСТРОЕ ПОВРЕЖДЕНИЕ ПОЧЕК У ПАЦИЕНТОВ С ТРОМБОЭМБОЛИЕЙ ЛЕГОЧНОЙ АРТЕРИИ

В.В. Филимонова, М.В. Мензоров, А.Ю. Большакова

ФГБОУ ВО «Ульяновский государственный университет», г. Ульяновск, Россия

 

Цель исследования. Оценить наличие, степень выраженности и варианты острого повреждения почек (ОПП) у пациентов с тромбоэмболией легочной артерии (ТЭЛА); уточнить связь между ОПП и расчетным риском смерти, госпитальной летальностью.

Материалы и методы. Обследовано 111 пациентов (мужчин – 61 (55 %), женщин – 50 (45 %), средний возраст – 66,8±11,7 года) с ТЭЛА, госпитализированных в отделение кардиологии ГУЗ «Центральная городская клиническая больница г. Ульяновска».

Результаты. Острое повреждение почек диагностировано у 36 (34 %) пациентов с ТЭЛА, причем у 24 (67 %) из них выявлена 1 стадия, у 7 (19 %) – 2 стадия и у 5 (14 %) – 3 стадия. У 20 (56 %) пациентов диагностирован догоспитальный вариант осложнения, госпитальное ОПП выявлялось в 16 (44 %) случаях. ОПП при ХБП имело место у 24 (67 %) обследованных, ОПП de novo – у 12 (33 %). В период госпитализации умерло 26 (23 %) пациентов. Относительный риск смерти в стационаре у пациентов с ОПП составил 5,2 (95 % ДИ: 2,02–13,39; р<0,001). Расчетный риск 30-дневной смерти по шкале PESI при наличии ОПП был выше, чем при его отсутствии
(120,0 (87,5–158,0) и 90 (87,5–158,0) соответственно, p=0,004).

Выводы. У пациентов с ТЭЛА наблюдается высокая частота ОПП, оно диагностируется у каждого 3-го пациента. У 67 % пациентов острое повреждение почек развивается на фоне предшествующей хронической болезни почек. Преобладают пациенты с догоспитальным ОПП (56 %). Острое повреждение почек у пациентов с ТЭЛА ассоциировано с увеличением госпитальной летальности и расчетного риска 30-дневной смертности.

Ключевые слова: острое повреждение почек, тромбоэмболия легочной артерии, госпитальная летальность, расчетный риск смерти.

 

Литература

  1. Мензоров М.В., Шутов А.М., Макеева Е.Р., Серов В.А., Михайлова Е.В., Парфёнова Е.А. Сложности диагностики острого повреждения почек у больных инфарктом миокарда с подъемом сегмента ST. Терапевтический архив. 2014; 4 (86): 25–29.

  2. Мензоров М.В., Шутов А.М., Макеева Е.Р., Страхов А.А. Острое повреждение почек у больных с острой декомпенсацией хронической сердечной недостаточности. Клиницист. 2013; 2: 29–33.

  3. Lewington A.J., Cerdá J., Mehta R.L. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013; 84 (3): 457–467.

  4. Chertow G.M., Burdick E., Honour M. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J. Am. Soc. Nephrol. 2005; 16: 3365–3370.

  5. Yang C.H., Chang C.H., Chen T.H. Combination of urinary biomarkers improves early detection of acute kidney injury in patients with heart failure. Circ. J. 2016; 80: 1017–1023.

  6. Abbott K.C., Cruess D.F., Agodoa L.Y., Sawyers E.S., Tveit D.P. Early renal insufficiency and late venous thromboembolism after renal transplantation in the United States. Am. J. Kidney Dis. 2004; 43: 120–130.

  7. Tveit D.P., Hypolite I.O., Hshieh P., Cruess D., Agodoa L.Y., Welch P.G. Chronic dialysis patients have high risk for pulmonary embolism. Am. J. Kidney Dis. 2002; 39: 1011–1017.

  8. Anderson F.A.Jr., Spencer F.A. Risk factors for venous thromboembolism. Circulation. 2003; 107: 9–16.

  9. Boettger B., Wehling M., Bauersachs R.M. Initial anticoagulation therapy in patients with venous thromboembolism and impaired renal function: results of an observational study. J. Public Health. 2014; 22: 89–99.

  10. Chang C.H., Fu C.M., Fan P.C., Chen S.W., Chang S.W., Mao C.T., Tian Y.C., Chen Y.C., Chu P.H., Chen T.H. Acute kidney injury in patients with pulmonary embolism: A population-based cohort study. Medicine (Baltimore). 2017; 96 (9): e5822.

  11. Martin Murgier, Laurent Bertoletti, Michael Darmon, FabriceZeni, Reina Valle, Jorge Del Toro, Pilar Llamas, Lucia Mazzolai, Aurora Villalobos, Manuel Monreal, RIETE Investigators. Frequency and Prognostic Impact of Acute Kidney Injury in Patients with Acute Pulmonary Embolism. Data from the RIETE Registry. Int. J. Cardiol. 2019; 291: 121–126.

  12. Trimaille A., Marchandot B., Girardey M., Muller C., Lim H.S., Trinh A., Ohlmann P., Moulin B., Jesel L., Morel O. Assessment of Renal Dysfunction Improves the Simplified Pulmonary Embolism Severity Index (sPESI) for Risk Stratification in Patients with Acute Pulmonary Embolism. J. Clin. Med. 2019; 8 (2): 160–174.

  13. Kostrubiec M., Pruszеzyk P., Bochowicz A. Biomarker-based risk assessment model in acute pulmonary embolism. Eur. Heart J. 2005; 26: 2166–2172.

  14. ESC Guideline on the diagnosis and management of acute Pulmonary Embolism. European Heart Journal. 2014; 35: 3033–3080.

  15. ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society. European Heart Journal. 2020; 41: 543–603.

  16. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. Kidney inter. Suppl. 2012; 2 (6): 1–138.

  17. Wilke T., Wehling M., Amann S., Bauersachs R.M., Böttger B. Renal impairment in patients with thromboembolic event: prevalence and clinical implications. A systematic review of the literature. Dtsch. Med. Wochenschr. 2015; 140 (17): 166–174.

Поступила в редакцию 09.02.2021; принята 10.04.2021.

 

Авторский коллектив

Филимонова Валентина Вячеславовна – аспирант кафедры терапии и профессиональных болезней, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-1293-4014

Мензоров Максим Витальевич – доктор медицинских наук, профессор кафедры терапии и профессиональных болезней, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-6000-4850

Большакова Анна Юрьевна – ординатор кафедры терапии и профессиональных болезней, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-0974-5407

 

Образец цитирования

Филимонова В.В., Мензоров М.В., Большакова А.Ю. Острое повреждение почек у пациентов с тромбоэмболией легочной артерии. Ульяновский медико-биологический журнал. 2021; 2: 36–45. DOI: 10.34014/2227-1848-2021-2-36-45.