High estimated pulmonary artery systolic pressure predicts adverse cardiovascular outcomes in stage 2–4 chronic kidney disease

Abstract

High estimated pulmonary artery systolic pressure (ePASP) is an established risk factor for mortality and cardiovascular (CV) events in the general population. High ePASP predicts mortality in dialysis patients but such a relationship has not been tested in patients with early CKD. Here we estimated the prevalence and the risk factors of high ePASP in 468 patients with CKD stage 2-4 and determined its prognostic power for a combined end point including cardiovascular death, acute heart failure, coronary artery disease, and cerebrovascular and peripheral artery events. High ePASP (35 mm Hg and above) was present in 108 CKD patients. In a multivariate logistic regression model adjusted for age, diabetes, hemoglobin, left atrial volume (LAV/BSA), left ventricular mass (LVM/BSA), and history of CV disease, age (OR, 1.06; 95% CI, 12 1.04-1.09) and LAV/BSA (OR, 1.05; 95% CI, 1.03-1.07) were the sole significant independent predictors of high ePASP. Elevated ePASP predicted a significantly high risk for the combined cardiovascular end point both in unadjusted analyses (HR, 2.70; 95% CI, 1.68-4.32) and in analyses adjusting for age, eGFR, hemoglobin, LAV/BSA, LVM/BSA, and the presence of diabetes and CV disease (HR, 1.75; 95% CI, 1.05-2.91). High ePASP is relatively common in patients with stage 2-4 CKD and predicts adverse CV outcomes independent of established classical and CKD-specific risk factors. Whether high ePASP is a modifiable risk factor in patients with CKD remains to be determined in randomized clinical trials.

Pulmonary Hypertension in CKD

“…Concordant with recent studies from Italy and China, 5,6 PH was prevalent in the CRIC, present in roughly one in five subjects (21%), and was significantly and indirectly related to the eGFR, rising from 6% among CKD stage 1 to 33% in CKD stage 5. As has been described in other studies, PH was associated with older age, systemic hypertension, diabetes, and a history of heart failure (HF).…”

“…As has been described in other studies, PH was associated with older age, systemic hypertension, diabetes, and a history of heart failure (HF). 5,7 Multivariable analysis found that older age, lower hemoglobin, lower left ventricular ejection fraction, and the presence of left ventricular hypertrophy were independently associated with PH. The presence of PH was associated with a 38% increased risk of overall mortality and a 23% increased risk of cardiovascular events (HF, myocardial infarction, cerebrovascular accident, and peripheral vascular disease).…”

Pulmonary Hypertension Is Associated with Mortality and Cardiovascular Events in Chronic Kidney Disease Patients

“…Recent studies suggest a higher prevalence of this entity in stage 5 non-dialysis dependent CKD patients [5,6] , HD patients [2,7,8] and peritoneal dialysis patients [9,10] compared to healthy individuals. A recently published paper has included stages 1-4 CKD patients and evaluated the outcomes [11] .…”

Effect of Renal Dysfunction on the Cardiacvascular System. The Possibili Ties of Early Diagnosis of the Renal Dysfunction

“…Показатель систолической экскурсии плоскости три-куспидального кольца (TAPSE), наряду с легочным артериальным давлением (ЛАД), один из широко из-ученных методов допплеровской Эхо-КГ оценки ПЖ и ассоциирован с неблагоприятными исходами [47]. Так, высокая ePASP является установленным факто-ром сердечно-сосудистого риска в общей популяции, но малоизвестно о систолическом ЛАД в ранние ста-дии ХБП [48,49]. Распространенность ePASP была оценена в двух исследованиях на больших когортах.…”

“…У паци-ентов в последние стадии ХБП -стадия С5, согласно KDOQI (Kidney Disease Outcomes Quality Initiative), уровень ePASP значительно превышает, чем среди населения в целом, составляя 9-39% среди получаю-щих консервативное лечение, 18,8-68,8% среди па-циентов, находящихся на гемодиализе [50] и 0-42% среди лиц, находящихся на перитонеальном диали-зе [33]. Легочная гипертензия при ХБП может быть связана с несколькими факторами риска, такими как анемия, апноэ, повышение симпатической активно-сти, воспаление, кальцификация сосудов и эндотели-альная дисфункция, но остается неясным патогенез легочной артериальной гипертензии (ЛАГ) на ран-них стадиях у пациентов с ХБП [13,48]. В одном исследовании показатели TAPSE и ePASP значительно отличались у больных с ХБП от кон-трольной группы здоровых лиц.…”