Pulmonary Embolism More Lethal in Kidney Disease

doi: 10.1097/01.NEP.0000424004.47261.a9
In Brief

Pulmonary embolism (PE) occurs more frequently in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) than in people with normal kidney function, according to a study published in the Clinical Journal of the American Society of Nephrology (2012;7:1584-1590).

The Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) was used to estimate the total number of admissions for PE among adult patients, who were classified into three categories: those with CKD, those with ESRD, and those with normal kidney function. The lead author of the study was Gagan Kumar, MD, and the senior author was Rahul Nanchal, MD, both of the Division of Pulmonary and Critical Care Medicine at the Medical College of Wisconsin.

“We estimated that there were 32,616,411 adult discharges from hospitals covered by the NIS 2007 database, 154,585 of whom had PE,” the study authors wrote. “We calculated that the overall number of admissions for the principal diagnosis of PE in 2007 was 66 per 100,000 among persons with normal kidney function, 204 per 100,000 among persons with CKD, and 527 per 100,000 among persons with ESRD.”

The unadjusted in-hospital mortality for PE was 3.2% in patients with normal kidney function, but mortality was significantly higher for those with CKD (6.7%) and ESRD (6.7%). The odds ratio for mortality in CKD and ESRD patients was 1.57 and 1.92, respectively, compared with individuals who had normal kidney function.

The median length of hospital stay in survivors was two days longer for ESRD patients and one day longer for CKD patients, and the numbers of patients with PE discharged to a health care facility were significantly higher for CKD or ESRD.

The limitations of the study include that the authors may not have been able to identify the diagnoses of CKD. Also, the analysis does not include people who developed PE after being admitted to the hospital for another diagnosis.

“These findings have implications for the diagnosis, treatment, and, importantly, prevention of PE in these cohorts,” the study authors wrote. “Given the increased risk of death from PE, future investigations should evaluate current deep vein thrombosis prophylaxis strategies for these cohorts of patients.

“Although persons with CKD and ESRD have both higher risk of PE and mortality from PE, risks associated with evaluation and associated costs of hospitalizations may be higher as well. Investigations focusing on cost-benefit analyses and determining the risk-benefit ratios of evaluating and treating persons with CKD and ESRD with PE are warranted.”

© 2012 Lippincott Williams & Wilkins, Inc.