D-Dimer to rule out pulmonary embolism in renal insufficiency.

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D-Dimer to rule out pulmonary embolism in renal insufficiency.

Am J Med. 2013 Dec 16;

Authors: Lindner G, Funk GC, Pfortmueller CA, Leichtle AB, Fiedler GM, Schwarz C, Exadaktylos AK, Puig S

BACKGROUND: D-Dimer levels are often elevated in renal insufficiency. The diagnostic accuracy of D-Dimer to rule out pulmonary embolism in patients with renal insufficiency is unclear.
METHODS: We evaluated the data of patients presenting to our emergency department and receiving computed tomography angiography (CTA) to rule out pulmonary embolism with measurement of D-Dimer and creatinine. Glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.
RESULTS: 1,305 patients were included. 1,067 (82%) had an eGFR exceeding 60 ml/min, 209 (16%) 30-60 ml/min and 29 (2%) <30 ml/min. 152 patients (12%) had D-Dimer below 500 μg/L. eGFR (R= -0.1122) correlated significantly with D-Dimer (p<0.0001). 169 patients (13%) were found to have pulmonary embolism. Sensitivity of D-Dimer for patients with an eGFR>60 ml/min was 96% (0.93 to 0.99) and 100% (100 to 100) for those with 30-60 ml/min, while specificity declined significantly with impaired renal function. AUC of the ROC for D-Dimer was 0.734 in patients with an eGFR of > 60 ml/min and 0.673 for 30-60 ml/min.
CONCLUSIONS: D-Dimer levels were elevated in patients with an eGFR<60 ml/min, but proved to be highly sensitive for the exclusion of pulmonary embolism. However, since almost all patients with impaired renal function had elevated D-Dimer irrespective of the presence of pulmonary embolism studies should be performed to determine renal function adjusted D-Dimer cut-offs.

PMID: 24355353 [PubMed - as supplied by publisher]

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