title: Chronic kidney disease: Prognostic marker of nonfatal pulmonary thromboembolism.
abstract: OBJECTIVE
  Renal dysfunction is associated with increased cardiovascular morbidity and mortality. The alteration in renal function as a marker of mortality in pulmonary thromboembolism (PTE) has not been studied extensively.
  
  
  METHODS
  Four hundred four consecutive patients diagnosed with non-high-risk PTE (without cardiogenic shock or blood pressure <90 mm Hg) were prospectively enrolled in the study between 2005-2010. Kidney function, based on glomerular filtration rate (GFR), calculated by the simplified modification in diet in renal disease (MDRD) equation (sMDRD); troponin I; B-type natriuretic peptide (BNP); and echocardiographic markers of right ventricular (RV) function were determined in survivors versus non-survivors after a 2-year follow-up.
  
  
  RESULTS
  GFR was significantly lower in non-survivors than in survivors: 51.85±19.08 mL/min/1.73 m2 and 71.65±23.21 mL/min/1.73 m2, respectively (p=0.000). The highest 2-year mortality rate (20%) was recorded in patients with moderate renal dysfunction associated with RV dysfunction. Using multivariate analysis, we found that GFR is an independent predictor of 2-year mortality (OR 0.973, 95% CI: 0.959-0.987, p=0.000), besides troponin I, dyslipidemia, acceleration time of pulmonary ejection, pericardial effusion, and BNP.
  
  
  CONCLUSIONS
  The association of renal dysfunction with right ventricular dysfunction in patients with non-fatal pulmonary thromboembolism resulted in high mortality. Renal dysfunction, assessed by glomerular filtration rate, may be used in the risk stratification of patients with non-high-risk pulmonary thromboembolism, besides troponin I, BNP, and right ventricle echocardiographic dysfunction markers.
authors: Grigore T.Popa University of Medicine and Pharmacy; Iaşi-România; IIIrd Medical Clinic from Sf. Spiridon University Hospital; Iaşi-România. floria_mariana@yahoo.com.
authors: Anca
authors: A
authors: Ouatu
authors: Daniela Maria
authors: DM
authors: Tãnase
authors: Mariana
authors: M
authors: Floria
authors: Simona Daniela
authors: SD
authors: Ionescu
authors: Valentin
authors: V
authors: Ambãruş
authors: Cãtãlina
authors: C
authors: Arsenescu-Georgescu
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000401:mortality / Q000503:physiopathology*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000503:physiopathology*; D012720:Severity of Illness Index; D014336:Troponin / Q000097:blood; D016278:Ventricular Function, Right
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides; D014336:Troponin