Objective We aimed to investigate the potential role of heart-kidney crosstalk after normotensive pulmonary embolism (PE) and the impact of anticoagulation on renal function recovery in PE patients with/without right ventricle (RV) dysfunction.

Design and Methods In a multicenter cohort study, data were collected from patients with acute PE. Patients without hemodynamic instability were analyzed. Demographics and RV function was assessed on admission. All available measurements of serum creatine (SCr) during hospitalization and follow-up were recorded to define acute kidney injury (AKI) by the KDIGO criteria. Occurrence and recovery of AKI were obtained and their associations with RV dysfunction and early anticoagulation were analyzed.

Results In a total of 489 acute PE patients recruited, 461 (94.3%) were normotensive. A transient elevation of SCr was observed. The incidence of AKI among normotensive patients was 18.9%. In normotensive PE patients, BNP/NT-proBNP elevation (adjusted hazard ratio (aHR) 2.08, 95% confident interval (CI) 1.31-3.29) and history of chronic kidney disease (CKD) (aHR 3.76, 95%CI 2.03-6.95) were associated with the development of AKI during hospitalization. Initiating anticoagulation treatment within 5 days after PE onset promoted early recovery of AKI (adjusted risk ratio [aRR] 1.57, 95%CI 1.09-2.26), and those had both BNP/NT-proBNP elevation and RV failure detected by imaging test benefitted the most (aRR 3.76, 95%CI 1.17-12.12).

Conclusions

Patients developed AKI would benefit from early anticoagulation therapy for an early recovery of renal function, especially among those comorbid with RV dysfunction.