Baseline Ratio of Soluble Fas/FasL Predicts Onset of Pulmonary Hypertension in Elder Patients Undergoing Maintenance Hemodialysis: A Prospective Cohort Study

Abstract

BackgroundPulmonary hypertension (PH) is one of the most common complications associated with end-stage renal disease (ESRD). Though numerous risk factors have been founded, other risk factors remain unidentified, particularly in patients undergoing maintenance hemodialysis with elder age. Soluble Fas (sFas) and its ligand FasL (sFasL) have been reported in chronic renal disease patients; however, they have not been identified in the PH patients of elder hemodialysis patients. We aimed to determine the roles of sFas/sFasL in onset of PH in elder patients undergoing maintenance hemodialysis with ESRD.MethodsAltogether, 163 patients aged 68.00 ± 10.51 years with ESRD who undergoing maintenance hemodialysis in a prospective cohort and were followed-up for a median of 5.5 years. They underwent echocardiography examinations, liver function assessments, residual renal function, and serum ion examinations, before and after dialysis. Furthermore, levels of sFas and sFasL at baseline had also been measured. We compared demographic data, echocardiographic parameters, liver function, ions, and residual renal function as well as serum sFas and sFasL between the PH and non-PH groups. These parameters were correlated with systolic pulmonary artery pressure (sPAP) using Spearman’s correlation. Moreover, univariate and adjusted logistic regression analyses have also been conducted.ResultsThe incidence of PH in the elder dialysis patients was 39.1%. PH populations were demonstrated with significantly higher end-diastolic internal diameters of the left atrium, left ventricle, right ventricle (RV), and pulmonary artery, as well as the left ventricular posterior wall thickness (LVWP; all p < 0.05). A higher baseline serum sFas and sFasL levels have also been identified ( p < 0.001). They also showed lower fractional shortening and left ventricular ejection fraction (LVEF; p < 0.05). Following dialysis, the post-dialysis serum potassium concentration (K+) was significantly higher in the PH group ( p = 0.013). Furthermore, the adjusted regression identified that ratio of sFas/FasL (OR: 1.587, p = 0.004), RV (OR: 1.184, p = 0.014), LVPW (OR: 1.517, p = 0.007), and post-dialysis K+ (OR: 2.717, p = 0.040) was the independent risk factors for PH while LVEF (OR: 0.875, p = 0.040) protects patients from PH.ConclusionThe baseline ratio of sFas/sFasL, RV, LVPW, and post-dialysis K+ was independent risk factors for PH onset, while LVEF was a protective factor for PH.

Meta-analysis of the correlation between pulmonary hypertension and echocardiographic parameters in patients with chronic kidney disease

“…Few of the existing articles have used either ‘multivariable logistic regression analysis’ or ‘propensity score matching’. It is expected that future studies will make greater use of these two methods to ensure that intergroup comparability and assessed relationships are not affected by other confounding factors ( Ding et al, 2022 ; Feng & Ren, 2020 ; Gao et al, 2021 ; He et al, 2015 ; Lv et al, 2019 ; Shen et al, 2021 ; Wang et al, 2014a , 2014b ; Yang & Bao, 2012 ; Yang & Bao, 2014 ; Zhang et al, 2020 ) (all the included articles are shown in 44–54 in the references).…”

Hemodynamic factors affecting pulmonary hypertension in hemodialysis patients

“…Therefore, approximately 44% of HD patients suffer from HF [23]. A decline in left heart function can predict the occurrence of PH [6], which leads to category 2 PH [13]. Taken together, fluid volume can affect PCWP and left heart function, subsequently conducting the TRV of the right heart.…”

“…Among hemodialysis (HD) patients, the prevalence of PH ranges from 12.6% to 47% in different countries [2][3][4][5]. In Chinese individuals, the prevalence ranges from 34.6% to 39.1% [6,7]. PH is an important predictor of morbidity and mortality in patients with HD.…”