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Review Article
Published online: 2021-01-14
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Does kidney function matter in pulmonary thromboembolism management?

Magdalena Pływaczewska, Piotr Pruszczyk, Maciej Kostrubiec
DOI: 10.5603/CJ.a2021.0005
·
Pubmed: 33470418

open access

Ahead of print
Review articles
Published online: 2021-01-14

Abstract

Cardiovascular circulation and kidney function are closely interrelated. The impairment of renal function is a well-known hazard of increased mortality and morbidity of patients with heart failure or coronary artery disease. Acute pulmonary embolism (APE) impacts pulmonary and systemic circulation, and can severely impair functions of other organs, including kidneys, as a result of hypoxemia and increased venous pressure.

Previous studies indicate that renal dysfunction predicts short- and long-term outcomes and can improve the risk assessment in APE. However, renal function should also be cautiously considered during the diagnostic workup because the contrast-induced nephropathy after computed tomography pulmonary angiography (CTPA) is noticed more frequently in APE. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but imminent complication of APE. This condition promotes renal impairment by increasing venous pressure and decreasing glomerular filtration. The renal function improvement and serum creatinine concentration reduction were noted in CTEPH subgroup with glomerular filtration rate ≤ 60 mL/min/1.73 m2 after successful treatment.

In this review, we present the essential research results on the kidney function in thromboembolism disease.

Abstract

Cardiovascular circulation and kidney function are closely interrelated. The impairment of renal function is a well-known hazard of increased mortality and morbidity of patients with heart failure or coronary artery disease. Acute pulmonary embolism (APE) impacts pulmonary and systemic circulation, and can severely impair functions of other organs, including kidneys, as a result of hypoxemia and increased venous pressure.

Previous studies indicate that renal dysfunction predicts short- and long-term outcomes and can improve the risk assessment in APE. However, renal function should also be cautiously considered during the diagnostic workup because the contrast-induced nephropathy after computed tomography pulmonary angiography (CTPA) is noticed more frequently in APE. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but imminent complication of APE. This condition promotes renal impairment by increasing venous pressure and decreasing glomerular filtration. The renal function improvement and serum creatinine concentration reduction were noted in CTEPH subgroup with glomerular filtration rate ≤ 60 mL/min/1.73 m2 after successful treatment.

In this review, we present the essential research results on the kidney function in thromboembolism disease.

Get Citation

Keywords

renal dysfunction, contrast-induced nephropathy, pulmonary embolism, chronic thromboembolic pulmonary hypertension, prognosis, mortality

About this article
Title

Does kidney function matter in pulmonary thromboembolism management?

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Review Article

Published online

2021-01-14

DOI

10.5603/CJ.a2021.0005

Pubmed

33470418

Keywords

renal dysfunction
contrast-induced nephropathy
pulmonary embolism
chronic thromboembolic pulmonary hypertension
prognosis
mortality

Authors

Magdalena Pływaczewska
Piotr Pruszczyk
Maciej Kostrubiec

References (67)
  1. McCullough P, Kellum J, Haase M, et al. Pathophysiology of the Cardiorenal Syndromes: Executive Summary from the Eleventh Consensus Conference of the Acute Dialysis Quality Initiative (ADQI). Blood Purification. 2014; 37(2): 2–13.
  2. Damman K, Valente MAE, Voors AA, et al. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J. 2014; 35(7): 455–469.
  3. Levey AS, Coresh J, Greene T, et al. Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006; 145(4): 247–254.
  4. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16(1): 31–41.
  5. Fu Q, Colgan SP, Shelley CS. Hypoxia: the force that drives chronic kidney disease. Clin Med Res. 2016; 14(1): 15–39.
  6. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019; 54(3).
  7. Moos SI, van Vemde DNH, Stoker J, et al. Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: a meta-analysis. Eur J Radiol. 2013; 82(9): e387–e399.
  8. Goldenberg I, Matetzky S. Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies. CMAJ. 2005; 172(11): 1461–1471.
  9. Mauritz GJ, Marcus JT, Westerhof N, et al. Prolonged right ventricular post-systolic isovolumic period in pulmonary arterial hypertension is not a reflection of diastolic dysfunction. Heart. 2011; 97(6): 473–478.
  10. Piazza G, Goldhaber SZ. The acutely decompensated right ventricle: pathways for diagnosis and management. Chest. 2005; 128(3): 1836–1852.
  11. Harjola VP, Mebazaa A, Čelutkienė J, et al. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Fail. 2016; 18(3): 226–241.
  12. Damman K, van Deursen VM, Navis G, et al. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol. 2009; 53(7): 582–588.
  13. Burrowes KS, Clark AR, Tawhai MH. Blood flow redistribution and ventilation-perfusion mismatch during embolic pulmonary arterial occlusion. Pulm Circ. 2011; 1(3): 365–376.
  14. Pisani A, Riccio E, Andreucci M, et al. Role of reactive oxygen species in pathogenesis of radiocontrast-induced nephropathy. Biomed Res Int. 2013; 2013: 868321.
  15. Kooiman J, Klok FA, Mos ICM, et al. Incidence and predictors of contrast-induced nephropathy following CT-angiography for clinically suspected acute pulmonary embolism. J Thromb Haemost. 2010; 8(2): 409–411.
  16. Doganay S, Oguz AK, Ergun I. Increased risk of contrast-induced acute kidney injury in patients with pulmonary thromboembolism. Ren Fail. 2015; 37(7): 1138–1144.
  17. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004; 44(7): 1393–1399.
  18. Jiménez D, Aujesky D, Moores L, et al. RIETE Investigators. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010; 170(15): 1383–1389.
  19. Ho KM, Harahsheh Y. Predicting contrast-induced nephropathy after CT pulmonary angiography in the critically ill: a retrospective cohort study. J Intensive Care. 2018; 6: 3.
  20. Mitchell AM, Jones AE, Tumlin JA, et al. Prospective study of the incidence of contrast-induced nephropathy among patients evaluated for pulmonary embolism by contrast-enhanced computed tomography. Acad Emerg Med. 2012; 19(6): 618–625.
  21. van der Molen AJ, Reimer P, Dekkers IA, et al. Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol. 2018; 28(7): 2856–2869.
  22. Turedi S, Erdem E, Karaca Y, et al. The high risk of contrast-induced nephropathy in patients with suspected pulmonary embolism despite three different prophylaxis: a randomized controlled trial. Acad Emerg Med. 2016; 23(10): 1136–1145.
  23. Kooiman J, Sijpkens YWJ, van Buren M, et al. Randomised trial of no hydration vs. sodium bicarbonate hydration in patients with chronic kidney disease undergoing acute computed tomography-pulmonary angiography. J Thromb Haemost. 2014; 12(10): 1658–1666.
  24. Timal RJ, Kooiman J, Sijpkens YWJ, et al. Effect of no prehydration vs sodium bicarbonate prehydration prior to contrast-enhanced computed tomography in the prevention of postcontrast acute kidney injury in adults with chronic kidney disease: the Kompas Randomized Clinical Trial. JAMA Intern Med. 2020; 180(4): 533–541.
  25. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999; 353(9162): 1386–1389.
  26. Zondag W, Vingerhoets LMA, Durian MF, et al. Hestia Study Investigators. Hestia criteria can safely select patients with pulmonary embolism for outpatient treatment irrespective of right ventricular function. J Thromb Haemost. 2013; 11(4): 686–692.
  27. Kostrubiec M, Pływaczewska M, Jiménez D, et al. The prognostic value of renal function in acute pulmonary embolism-a multi-centre cohort study. Thromb Haemost. 2019; 119(1): 140–148.
  28. Pływaczewska M, Skowrońska M, Dzikowska-Diduch O, et al. Prognosis assesment in patients with acute pulmonary embolism using GFR, based on the sPESI scale and plasma troponin concentration. The 4 th International Spring School The science and practice of VTE. Abstract Book. 2019; May: 36–37.
  29. Catella J, Bertoletti L, Mismetti P, et al. investigators of the RIETE registry. Severe renal impairment and risk of bleeding during anticoagulation for venous thromboembolism. J Thromb Haemost. 2020; 18(7): 1728–1737.
  30. Kostrubiec M, Łabyk A, Pedowska-Włoszek J, et al. Assessment of renal dysfunction improves troponin-based short-term prognosis in patients with acute symptomatic pulmonary embolism. J Thromb Haemost. 2010; 8(4): 651–658.
  31. Altınsoy B, Öz İİ, Örnek T, et al. Prognostic value of renal dysfunction indicators in normotensive patients with acute pulmonary embolism. Clin Appl Thromb Hemost. 2017; 23(6): 554–561.
  32. KDIGO 2012: Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International Supplements. 2013; 3(1): 134–135.
  33. Kjeldsen L, Cowland J, Borregaard N. Human neutrophil gelatinase-associated lipocalin and homologous proteins in rat and mouse. Biochim Biophys Acta. 2000; 1482(1-2): 272–283.
  34. Coca SG, Yalavarthy R, Concato J, et al. Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review. Kidney Int. 2008; 73(9): 1008–1016.
  35. Kostrubiec M, Łabyk A, Pedowska-Włoszek J, et al. Neutrophil gelatinase-associated lipocalin, cystatin C and eGFR indicate acute kidney injury and predict prognosis of patients with acute pulmonary embolism. Heart. 2012; 98(16): 1221–1228.
  36. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J. 2015; 46: 903–975.
  37. Ende-Verhaar YM, Cannegieter SC, Vonk Noordegraaf A, et al. Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature. Eur Respir J. 2017; 49(2).
  38. Lang IM, Madani M. Update on chronic thromboembolic pulmonary hypertension. Circulation. 2014; 130(6): 508–518.
  39. Gajanana D, Mezue K, George J, et al. Effects of pulmonary hypertension on kidney function. Clin Pulm Med. 2017; 24(1): 26–28.
  40. Mullens W, Abrahams Z, Francis GS, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol. 2009; 53(7): 589–596.
  41. Sarnak MJ. A patient with heart failure and worsening kidney function. Clin J Am Soc Nephrol. 2014; 9(10): 1790–1798.
  42. Heymes C, Bendall JK, Ratajczak P, et al. Increased myocardial NADPH oxidase activity in human heart failure. J Am Coll Cardiol. 2003; 41(12): 2164–2171.
  43. Nickel NP, O'Leary JM, Brittain EL, et al. Kidney dysfunction in patients with pulmonary arterial hypertension. Pulm Circ. 2017; 7(1): 38–54.
  44. Nootens M, Kaufmann E, Rector T, et al. Neurohormonal activation in patients with right ventricular failure from pulmonary hypertension: Relation to hemodynamic variables and endothelin levels. J Am Coll Cardiol. 1995; 26(7): 1581–1585.
  45. de Man FS, Tu Ly, Handoko ML, et al. Dysregulated renin-angiotensin-aldosterone system contributes to pulmonary arterial hypertension. Am J Respir Crit Care Med. 2012; 186(8): 780–789.
  46. Sise ME, Courtwright AM, Channick RN. Pulmonary hypertension in patients with chronic and end-stage kidney disease. Kidney Int. 2013; 84(4): 682–692.
  47. Navaneethan SD, Roy J, Tao K, et al. Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD. J Am Soc Nephrol. 2016; 27(3): 877–886.
  48. Riedel M, Stanek V, Widimsky J, et al. Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. Chest. 1982; 81(2): 151–158.
  49. Mayer E, Jenkins D, Lindner J, et al. Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. J Thorac Cardiovasc Surg. 2011; 141(3): 702–710.
  50. Madani MM, Auger WR, Pretorius V, et al. Pulmonary endarterectomy: recent changes in a single institution's experience of more than 2,700 patients. Ann Thorac Surg. 2012; 94(1): 97–103; discussion 103.
  51. Delcroix M, Lang I, Pepke-Zaba J, et al. Long-Term outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. Circulation. 2016; 133(9): 859–871.
  52. Mahmud E, Madani MM, Kim NH, et al. Chronic thromboembolic pulmonary hypertension: evolving therapeutic approaches for operable and inoperable disease. J Am Coll Cardiol. 2018; 71(21): 2468–2486.
  53. Freed DH, Thomson BM, Berman M, et al. Survival after pulmonary thromboendarterectomy: effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg. 2011; 141(2): 383–387.
  54. Wilkens H, Konstantinides S, Lang IM, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): Updated Recommendations from the Cologne Consensus Conference 2018. Int J Cardiol. 2018; 272S: 69–78.
  55. Mizoguchi H, Ogawa A, Munemasa M, et al. Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv. 2012; 5(6): 748–755.
  56. Roik M, Wretowski D, Łabyk A, et al. Refined balloon pulmonary angioplasty-A therapeutic option in very elderly patients with chronic thromboembolic pulmonary hypertension. J Interv Cardiol. 2017; 30(3): 249–255.
  57. Zoppellaro G, Badawy MR, Squizzato A, et al. Balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis. Circ J. 2019; 83(8): 1660–1667.
  58. Darocha S, Banaszkiewicz M, Pietrasik A, et al. Changes in estimated glomerular filtration after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Cardiorenal Med. 2020; 10(1): 22–31.
  59. Marenzi G, Cosentino N, Bartorelli AL. Acute kidney injury in patients with acute coronary syndromes. Heart. 2015; 101(22): 1778–1785.
  60. Kriechbaum SD, Wiedenroth CB, Hesse ML, et al. Development of renal function during staged balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension. Scand J Clin Lab Invest. 2019; 79(4): 268–275.
  61. Kimura M, Kataoka M, Kawakami T, et al. Balloon pulmonary angioplasty using contrast agents improves impaired renal function in patients with chronic thromboembolic pulmonary hypertension. Int J Cardiol. 2015; 188: 41–42.
  62. Isobe S, Itabashi Y, Kawakami T, et al. Increasing mixed venous oxygen saturation is a predictor of improved renal function after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. Heart Vessels. 2019; 34(4): 688–697.
  63. Naranjo M, Lo KB, Mezue K, et al. Effects of pulmonary hypertension and right ventricular function in short and long-term kidney function. Curr Cardiol Rev. 2019; 15(1): 3–11.
  64. Navaneethan SD, Roy J, Tao K, et al. Prevalence, predictors, and outcomes of pulmonary hypertension in CKD. J Am Soc Nephrol. 2016; 27(3): 877–886.
  65. Chakinala MM, Coyne DW, Benza RL, et al. Predicting outcomes in pulmonary arterial hypertension based on estimated glomerular filtration rate. Am J Respir Crit Care Med. 2016; 193: A6316.
  66. Bolignano D, Rastelli S, Agarwal R, et al. Pulmonary hypertension in CKD. Am J Kidney Dis. 2013; 61(4): 612–622.
  67. Simonneau G, Montani D, Celermajer D, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019; 53(1): 1801913.

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