Risk factors for pulmonary hypertension in patients receiving maintenance peritoneal dialysis

Yin, Zhang; Yang, Danwen; Feng, Sheng; Shen, Huaying; Wang, Z.; Jiang, Shan; Shi, Yong; Fu, Jinxiang

doi:10.1590/1414-431x20154733

Cited by 12 publications

(15 citation statements)

References 38 publications

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“…Using meta-analysis, the pooled prevalence estimates of PAH were similar to the median prevalence estimates but had high statistical heterogeneity. The difference in pooled prevalence among those receiving HD versus PD was signi cant (Chi-squared 27.53, df 1, p < 0.00001) (33). In our study the prevalence of PAH (24.2%) was more or less in line with those reported in previous studies (34)(35)(36).…”

Section: Resultssupporting

confidence: 88%

“…This is of signi cant interest and importance due to the large numbers of ESRD patients (in 2016 there were more than 700,000 patients with ESRD in the US alone, with prevalence increasing by approximately 20,000 per year) (32) Many researchers have studied PAH in ESRD on hemodialysis but few studies (only 11) have investigated the same with PD as stated in a recent metanalysis (33). The sPAP used to diagnose PAH varied among studies; the most common threshold was an sPAP > 35 mmHg but ranged from > 30 mmHg to > 45 mmHg (33). Compared with hemodialysis (HD), the prevalence of PAH was much less in ESRD patients receiving treatment with PD.…”

Section: Resultsmentioning

confidence: 99%

“…However, visual inspection of the Forest Plots suggested that the heterogeneity may be attributable to there being three categories of studies, those reporting low, moderate, and high prevalence of PAH. When the three categories of studies were pooled separately, the heterogeneity nearly disappeared (33). Studies from the Middle East and North Africa (34-38) had a pooled prevalence among patients undergoing any type of dialysis of 38% (95% CI 30-45%), among patients receiving HD of 42% (95% CI 35-50%), and among patients receiving PD of 15% (95% CI 9-21%).…”

Section: Resultsmentioning

confidence: 99%

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The Problem of Pulmonary Artery Hypertension in End-Stage Renal Disease: Can Peritoneal Dialysis be the Solution

Al-Hwiesh¹,

Abdulrahman²,

Alshehri³

et al. 2020

Preprint

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Background: Pulmonary artery hypertension (PAH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PAH among patients with ESRD treated with automated peritoneal dialysis (APD), investigated the effect of different variables and compared pulmonary artery pressure and cardiac function at the beginning and end of the study. Methods: The study that started on 2015 and extended till 2020. Thirty-one ESRD patients on APD were recruited after fulfilling inclusion criteria. Blood samples were collected from all patients for the biochemical and hematological data at the beginning of the study and every month and at the study termination. Total body water (TBW) and extracellular water (ECW) were calculated using Watson’s and Bird’s calculation methods. All patients were followed-up monthly by cardiologist for an echocardiographic examination. Cox regression analysis was used to assess the relation between different variables and PAH.Results: The mean age of the study population (n=31) was 51.23±15.24 years. PAH was found in 24.2% of the patients. Mean systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) were significantly higher in the APD patients at study initiation than at the end of the study (40.75 + 10.61 vs 23.55 + 9.20 and 29.66 + 11.35 vs 18.24 + 6.75 mmHg respectively, p = 0.001). The median ejection fraction was significantly lower in patients with PAH at zero point than at study termination [31% (27-34) vs 50% (46-52), p = 0.002]. Hypervolemia decreased significantly at the end of study (p <0.001) and correlated positively with the PAP (r = 0.371 and r = 0.369), p = 0.002). sPAP correlated with left ventricular mass index, hemoglobin level, and duration on APD.Conclusions: Long term PD (> 2 years) seemed to decrease pulmonary artery pressure, right atrial pressure and improve left ventricular ejection fraction (LVEF). Risk factors for PAH in ESRD were hypervolemia, abnormal ECHO findings and low hemoglobin levels. Clinical and echocardiographic abnormalities and complications are not uncommon among ESRD patients with PAH. Identification of those patients on and transthoracic echocardiography may warrant further attention to treatment with APD.

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Section: Resultssupporting

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Problem of Pulmonary Artery Hypertension in End-Stage Renal Disease: Can Peritoneal Dialysis be the Solution

Al-Hwiesh¹,

Abdulrahman²,

Alshehri³

et al. 2020

Preprint

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show abstract

“…2,4 Peritoneal dialysis (PD) patients also appear to have a high prevalence of PH. 5 The pathophysiology of PH in patients with end-stage renal disease (ESRD) is not known. Many possible reasons for the development of PH in this population have been proposed and studied, with conflicting results, including imbalance between vasoconstrictors and vasodilators, 6 mineral and bone disorders (MBD) associated with CKD, 7,8 high-flow arteriovenous fistulas used for dialysis access, 6 anaemia, 4,9 recurrent pulmonary embolisms, 10 fluid overload 11 left ventricular (LV) systolic and diastolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of new onset PH after initiation of maintenance HD is high, and prevalence increases with number of years spent receiving dialysis . Peritoneal dialysis (PD) patients also appear to have a high prevalence of PH …”

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confidence: 99%