Internal and Emergency Medicine

, Volume 8, Issue 8, pp 735–740

In-hospital mortality for pulmonary embolism: relationship with chronic kidney disease and end-stage renal disease. The hospital admission and discharge database of the Emilia Romagna region of Italy

  • Fabio Fabbian
  • Massimo Gallerani
  • Marco Pala
  • Alfredo De Giorgi
  • Raffaella Salmi
  • Fabio Manfredini
  • Francesco Portaluppi
  • Francesco Dentali
  • Walter Ageno
  • Dimitri P. Mikhailidis
  • Roberto Manfredini


The impact of chronic kidney disease (CKD) on the outcome of acute pulmonary embolism (PE) is uncertain. We aimed to evaluate the effect of renal dysfunction (defined by ICD-9-CM codification) on in-hospital mortality for PE. We considered all cases of PE (first event) recorded in the database of hospital admissions for the Emilia-Romagna region, Italy, from 1999 to 2009. The inclusion criterion was the presence, as a main discharge diagnosis, of acute PE codes according to ICD-9-CM. Diagnoses of immobilization, dementia, sepsis, skeletal fractures, hypertension, heart failure, myocardial infarction, diabetes mellitus, peripheral vascular disease, cerebrovascular disease, chronic pulmonary disease, pneumonia, malignancy, CKD and end-stage renal disease (ESRD) were also considered to evaluate comorbidity. The outcome was in-hospital mortality for PE, and multivariate logistic regression analyses was performed. We considered 24,690 cases of first episode of PE. In-hospital mortality for PE was not different in patients without renal dysfunction, with CKD, or ESRD (23.6 vs. 24 vs. 18 % p = ns). In-hospital mortality for PE was independently associated with age (OR 1.045, 95 % CI 1.042–1.048, p < 0.001), female sex (OR 1.322, 95 % CI 1.242–1.406, p < 0.001), hypertension (OR 1.096, 95 % CI 1.019–1.178, p = 0.013), diabetes mellitus (OR 1.120, 95 % CI 1.001–1.253, p = 0.049), dementia (OR 1.171, 95 % CI 1.020–1.346, p = 0.025), peripheral vascular disease (OR 1.349, 95 % CI 1.057–1.720, p = 0.016) and malignancy (OR 1.065, 95 % CI 1.016–1.116, p = 0.008). Age and comorbidity are associated with in-hospital mortality for PE, whereas CKD does not appear to be an independent predictor of adverse outcomes in patients hospitalized for PE.


Pulmonary embolism Mortality Chronic kidney disease End-stage renal disease Comorbidity ICD-9-CM codification 


  1. 1.
    Foley RN, Collins AJ (2011) A novel model of cardiovascular risk based on kidney function. Am J Nephrol 34:505–511PubMedCrossRefGoogle Scholar
  2. 2.
    Schena FP (2011) Management of patients with chronic kidney disease. Intern Emerg Med 6(suppl 1):S77–S83CrossRefGoogle Scholar
  3. 3.
    Manfredini R, Portaluppi F, Grandi E, Fersini C, Gallerani M (1996) Out-of-hospital sudden death referring to an emergency department. J ClinEpidemiol 49:865–868CrossRefGoogle Scholar
  4. 4.
    Squizzato A, Luciani D, Rubboli A et al (2012) Differential diagnosis of pulmonary embolism in outpatients with non-specific cardiopulmonary symptoms. Intern Emerg Med. doi:10.1007/s11739-011-0725-1 Google Scholar
  5. 5.
    Becattini C, Agnelli G (2007) Acute pulmonary embolism: risk stratification in the emergency department. Intern Emerg Med 2:119–129PubMedCrossRefGoogle Scholar
  6. 6.
    Mossey RT, Kasabian AA, Wilkes BM, Mailloux LU, Susin M, Bluestone PA (1982) Pulmonary embolism low incidence in chronic renal failure. Arch Intern Med 142:1646–1648PubMedCrossRefGoogle Scholar
  7. 7.
    National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 39(Suppl. 1):S1–S266Google Scholar
  8. 8.
    de Jager DJ, Grootendorst DC, Jager KJ et al (2009) Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA 302:1782–1789PubMedCrossRefGoogle Scholar
  9. 9.
    Calderon K, Jhaveri KD, Mossey R (2010) Pulmonary embolism following thrombolysis of dialysis access: is anticoagulation relay necessary? Semin Dial 23:522–525PubMedCrossRefGoogle Scholar
  10. 10.
    Finazzi G, Mingardi G (2009) Oral anticoagulant therapy in hemodialysis patients: do the benefits outweight the risks? Intern Emerg Med 4:375–380PubMedCrossRefGoogle Scholar
  11. 11.
    Fabbian F, De Giorgi A, Pala M et al (2011) Low molecular weight heparins and glomerular filtration rate: a report to be considered. Curr Vasc Pharmacol 9:693–697PubMedCrossRefGoogle Scholar
  12. 12.
    Lim W, Dentali F, Eikelboom JW, Crowther MA (2006) Meta-analysis: low-molecular-weight heparin and bleeding in patients with severe renal insufficiency. Ann Intern Med 144:673–684PubMedCrossRefGoogle Scholar
  13. 13.
    Fairshter RD, Vaziri ND, Mirahmadi MK (1982) Lung pathology in chronic hemodialysis patients. Int J Artif Organs 5:97–100PubMedGoogle Scholar
  14. 14.
    Wiesholzer M, Kitzwögerer M, Harm F et al (1999) Prevalence of preterminal pulmonary thromboembolism among patients on maintenance hemodialysis treatment before and after introduction of recombinant erythropoietin. Am J Kidney Dis 33:702–708PubMedCrossRefGoogle Scholar
  15. 15.
    Tveit DP, Hypolite IO, Hshieh P et al (2002) Chronic dialysis patients have high risk for pulmonary embolism. Am J Kidney Dis 39:1011–1017PubMedCrossRefGoogle Scholar
  16. 16.
    Tveit DP, Hshieh P, Cruess D, Agodoa LY, Welch PG, Abbott KC (2002) Risk factors for pulmonary embolism in chronic dialysis patients. J Nephrol 15:241–247PubMedGoogle Scholar
  17. 17.
    Monreal M, Falgà C, Valle R et al (2006) Venous thromboembolism in patients with renal insufficiency: findings from the RIETE registry. Am J Med 119:1073–1079PubMedCrossRefGoogle Scholar
  18. 18.
    Wattanakit K, Cushman M, Stehman-Breen C, Heckbert SR, Folsom AR (2008) Chronic kidney disease increases risk for venous thromboembolism. J Am SocNephrol 19:135–140Google Scholar
  19. 19.
    Folsom AR, Lutsey PL, Wattanakit K, Heckbert SR, Cushman M (2010) Chronic kidney disease and venous thromboembolism: a prospective study. Nephrol Dial Transplant 25:3296–3301PubMedCrossRefGoogle Scholar
  20. 20.
    Parikh AM, Spencer FA, Lessard D et al (2011) Venous thromboembolism in patients with reduced estimated GFR: a population based perspective. Am J Kidney Dis 58:746–755PubMedCrossRefGoogle Scholar
  21. 21.
    Kumar G, Sakhuja A, Taneja A et al. (2012) Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol (Jul 26 Epub ahead of print)Google Scholar
  22. 22.
    Penaloza A, Roy PM, Kline J (2012) Risk stratification and treatment strategy of pulmonary embolism. Curr Opin Crit Care 18:318–325PubMedCrossRefGoogle Scholar
  23. 23.
    Jiménez D, Aujesky D, Yusen RD (2010) Risk stratification of normotensive patients with acute symptomatic pulmonary embolism. Br J Haematol 151:415–424PubMedCrossRefGoogle Scholar
  24. 24.
    Htike N, Superdock K, Thiruveedi S, Surkis W, Teehan G (2012) Evaluating proteinuria and nephrotic syndrome in patients with venous thromboembolism. Am J Med Sci 343:124–126PubMedCrossRefGoogle Scholar
  25. 25.
    Mangione F, Dal Canton A (2011) Chronic kidney disease: myth and reality. Intern Emerg Med 6(suppl 1):S69–S76CrossRefGoogle Scholar
  26. 26.
    Di Minno MND, Tufano A, Ageno W, Prandoni P, Di Minno G (2012) Identifying high-risk individuals for cardiovascular disease: similarities between venous and arterial thrombosis in perspective. A 2011 update. Intern Emerg Med 7:9–13PubMedCrossRefGoogle Scholar
  27. 27.
    Fabbian F, Pala M, De Giorgi A et al (2012) In-hospital mortality in patients with renal dysfunction admitted for myocardial infarction: the Emilia-Romagna region of Italy database of hospital admissions. Int Urol Nephrol. doi:10.1007/s11255-012-0250-9 PubMedGoogle Scholar

Copyright information

© SIMI 2012

Authors and Affiliations

  • Fabio Fabbian
    • 1
  • Massimo Gallerani
    • 2
  • Marco Pala
    • 1
  • Alfredo De Giorgi
    • 1
  • Raffaella Salmi
    • 3
  • Fabio Manfredini
    • 4
  • Francesco Portaluppi
    • 5
  • Francesco Dentali
    • 6
  • Walter Ageno
    • 6
  • Dimitri P. Mikhailidis
    • 7
  • Roberto Manfredini
    • 8
  1. 1.Clinica MedicaAzienda Ospedaliera-Universitaria, University of FerraraCona, FerraraItaly
  2. 2.First Unit of Internal MedicineAzienda Ospedaliera-UniversitariaFerraraItaly
  3. 3.Second Unit of Internal MedicineAzienda Ospedaliera-UniversitariaFerraraItaly
  4. 4.Vascular Disease CenterAzienda Ospedaliera-Universitaria, University of FerraraFerraraItaly
  5. 5.Clinica Medica and Hypertension CenterUniversity Hospital S. Anna and University of FerraraFerraraItaly
  6. 6.Department of Clinical MedicineUniversity of InsubriaVareseItaly
  7. 7.Department of Clinical Biochemistry (Vascular Disease Prevention Clinics)University College London (UCL) Medical SchoolLondonUK
  8. 8.Clinica Medica and Vascular Diseases CenterAzienda Ospedaliera-Universitaria, University of FerraraFerraraItaly

Personalised recommendations