• Am. J. Med. Sci. · Jan 2025

    Impact of Kidney Disease in Patients Undergoing Catheter Directed Interventions for Intermediate to High-Risk Pulmonary Embolism.

    • Shafaqat Ali, Yehya Khlidj, Manoj Kumar, Thannon Alsaeed, Faryal Farooq, Bijeta Keisham, Pramod Kumar Ponna, Sanchit Duhan, Vijaywant Brar, Malalai Manan, Mahin R Khan, Mohammad Alfrad Nobel Bhuiyan, Aviral Vij, Steve Attanasio, Arman Qamar, and Tarek Helmy.
    • Department of Medicine, Louisiana State University Health Science Center, Shreveport, LA, USA. Electronic address: shafaqat231@gmail.com.
    • Am. J. Med. Sci. 2025 Jan 7.

    BackgroundCatheter-directed interventions (CDIs) for pulmonary embolism (PE) continue to evolve. However, due to the paucity of data, their use has been limited in patients with underlying kidney disease.MethodsThe National Readmission Database (2016-2020) was utilized to identify intermediate to high-risk PE (IHR-PE) patients requiring CDI (thrombectomy, thrombolysis, and ultrasound-assisted thrombolysis). Cohorts were stratified based on the presence of CKD stage ≥3, including ESRD. A Propensity Score Matching (PSM) model was applied to compare outcomes.ResultsFrom 2016-2020, 20795 patients with IHR-PE underwent CDIs. Most were done in the non-CKD/ESRD population (N:18438, 88.7%), while only 2357 (11.3%) were done in the CKD/ESRD population. After propensity matching, the CKD/ESRD population had higher adverse events, including mortality (7.3% vs. 5.1%, p: 0.036), need for transfusions (52.6% vs. 44.7%, p<0.001), and acute bleeding (15.4% vs. 10.6%, p<0.001). CKD/ESRD population had a higher median LOS (5 vs. 4 days, p<0.001) and total cost ($32935 vs. $29805, p<0.001) in the index admission. Over the study period, total cost decreased in the CKD/ESRD population ($37829 to $31436, p-trend: 0.024) but remained the same in the non-CKD/ESRD population (p-trend>0.05). 180-day readmission rates were higher in the CKD/ESRD population (24.7% vs. 17.5%, p: 0.006). Our subgroup analysis, excluding ESRD patients, showed no significant difference in in-hospital mortality (6.5% vs. 7.3%, p>0.05), but the rates of thoracic or respiratory bleeding (4.5% vs. 2.6%, p:0.012), need for transfusions (52.4% vs.. 43.5%, p<0.001), and AKI (57.1% vs. 23.2%, p<0.001) were higher in patients with CKD undergoing CDIs for IHF-PE.ConclusionCKD/ESRD patients requiring catheter-directed interventions for IHR-PE had higher periprocedural mortality and acute bleeding. The presence of ESRD mainly drove periprocedural mortality in our study, while the presence of non-dialyzed CKD was associated with higher rates of non-fatal localized hemorrhage.Copyright © 2025. Published by Elsevier Inc.

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