Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Navaneethan, Sankar D.; Wehbe, Edgard; Heresi, Gustavo A.; Gaur, Varun; Minai, Omar A.; Arrigain, Susana; Nally, Joseph V.; Schold, Jesse D.; Rahman, Mahboob; Dweik, Raed A.

doi:10.2215/cjn.10191013

Cited by 51 publications

(54 citation statements)

References 30 publications

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“…Shah et al [14], in their retrospective analysis of 500 incident PAH patients, demonstrated a univariate association of eGFR with RAP and CI. In 118 incident patients with PH (comprising WHO groups 1, 3, 4, and 5), Leuchte et al [15] also found a significant correlation of creatinine clearance with RAP and CI, while Navaneetha et al [17] observed a significant negative correlation with RAP in 1,088 PH patients (mainly WHO groups 1 and 2) [15]. Conversely, in a recent study in 64 patients with WHO groups 1, 3, and 4 PH, eGFR was significantly correlated with CI only [18].…”

Section: Discussionmentioning

confidence: 99%

“…Shah et al [14] found an increased risk of death in PAH patients with a serum creatinine above 123 µmol/L, while Kaiser et al [18] identified a nearly 3-fold unadjusted increase in mortality if eGFR was below 80 mL/min/1.73 m 2 . Finally, Navaneethan et al [17] identified a 5% increase in the risk of death per 5 mL/min/1.73 m 2 decrease in eGFR in a heterogeneous cohort of PH (including group 2). Our study demonstrates that CKD at PAH diagnosis is associated with a nearly doubled risk of death, independent of other usual risk factors [4, 5].…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of CKD in PAH patients varies from 4 to 38%, a broad range potentially related to the multiplicity of renal function estimators, or to PH etiology and severity [6, 14-17]. Likewise, hemodynamic parameters which may alter GFR in PAH patients remain uncertain, as previous studies presented methodological limitations: heterogeneous PH populations, presence of left heart failure patients, short-term follow-up, inaccurate GFR estimators, or univariate statistical approach [14-18].…”

Section: Introductionmentioning

confidence: 99%

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Presence of Kidney Disease as an Outcome Predictor in Patients with Pulmonary Arterial Hypertension

et al. 2018

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Background: Pulmonary arterial hypertension (PAH) may lead to right heart failure and subsequently alter glomerular filtration rates (GFR). Chronic kidney disease (CKD, GFR <60 mL/min/1.73 m²) may also adversely affect PAH prognosis. This study aimed to assess how right heart hemodynamics was associated with reduced estimated GFR (eGFR) and the association of CKD with survival in PAH patients. Methods: In a prospective PAH cohort (2003–2012), invasive hemodynamics and eGFR were collected at diagnosis (179 patients) and during follow-up (159 patients). The prevalence of CKD was assessed at PAH diagnosis. Variables, including hemodynamics, associated with reduced eGFR at diagnosis and during follow-up were tested in multivariate analysis. The association of CKD with survival was evaluated using a multivariate Cox regression model. Results: At diagnosis, mean age was 60.4 ± 16.5 years, mean pulmonary arterial pressure was 43 ± 12 mm Hg, and eGFR was 74.4 ± 26.4 mL/min/1.73 m². CKD was observed in 52 incident patients (29%). Independent determinants of reduced eGFR at diagnosis were age, systemic hypertension, and decreased cardiac index. Independent determinants of reduced eGFR during follow-up were age, female gender, PAH etiology, systemic hypertension, decreased cardiac index, and increased right atrial pressure. Age ≥60 years, female gender, NYHA 4, and CKD at diagnosis were independently associated with decreased survival. The adjusted hazards ratio for death associated with CKD was 1.81 (95% confidence interval [1.01–3.25]). Conclusion: CKD is frequent at PAH diagnosis and is independently associated with increased mortality. Right heart failure may induce renal hypoperfusion and congestion, and is associated with eGFR decrease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Presence of Kidney Disease as an Outcome Predictor in Patients with Pulmonary Arterial Hypertension

et al. 2018

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“…[7][8][9][10] PH, defined by elevated pulmonary arterial pressure, is rare in the general population but seen in 30%-40% of patients with ESRD (on the basis of echocardiographic studies). 11,12 After it is established, PH is often progressive and associated with high morbidity and mortality.…”

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confidence: 99%

Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD

Navaneethan

Roy

Tao

et al. 2016

Journal of the American Society of Nephrology

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Pulmonary hypertension (PH) is associated with poor outcomes in the dialysis and general populations, but its effect in CKD is unclear. We evaluated the prevalence and predictors of PH measures and their associations with long-term clinical outcomes in patients with nondialysis-dependent CKD. Chronic Renal Insufficiency Cohort (CRIC) Study participants who had Doppler echocardiography performed were considered for inclusion. PH was defined as the presence of estimated pulmonary artery systolic pressure (PASP) .35 mmHg and/or tricuspid regurgitant velocity (TRV) .2.5 m/s. Associations between PH, PASP, and TRV and cardiovascular events, renal events, and all-cause mortality were examined using Cox proportional hazards models. Of 2959 eligible participants, 21% (n=625) had PH, with higher rates among those with lower levels of kidney function. In the multivariate model, older age, anemia, lower left ventricular ejection fraction, and presence of left ventricular hypertrophy were associated with greater odds of having PH. After adjusting for relevant confounding variables, PH was independently associated with higher risk for death (hazard ratio, 1.38; 95% confidence interval, 1.10 to 1.72) and cardiovascular events (hazard ratio, 1.23; 95% confidence interval, 1.00 to 1.52) but not renal events. Similarly, TRV and PASP were associated with death and cardiovascular events but not renal events. In this study of patients with CKD and preserved left ventricular systolic function, we report a high prevalence of PH. PH and higher TRV and PASP (echocardiographic measures of PH) are associated with adverse outcomes in CKD. Future studies may explain the mechanisms that underlie these findings.

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“…A recent meta-analysis showed that among all subgroups of patients with HF, the presence of impaired renal function was significantly associated with mortality and had even greater prognostic significance among those with HF with preserved ejection fraction (HFpEF) [3]. Various studies have shown that HF, including HFpEF, is associated with worsening renal function [4-6], with right ventricular (RV) dysfunction and elevated right atrial (RA) pressures being implicated in the pathophysiology of progressive cardiorenal syndrome (CRS) [7, 8]. …”

Section: Introductionmentioning

confidence: 99%

Echocardiographic and Hemodynamic Parameters Associated with Diminishing Renal Filtration among Patients with Heart Failure with Preserved Ejection Fraction

Mezue

Ram

et al. 2018

Cardiorenal Med

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Background: Renal dysfunction is an important predictor of poor outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction is implicated as one of the explanations for worsening renal function in cardiorenal syndrome. Novel right heart catheterization (RHC) parameters such as pulmonary artery pulsatility index (PAPi) and right atrial to pulmonary capillary wedge pressure ratio (RA:PCWP) have been found as predictors of RV dysfunction. However, most studies investigating these parameters have been done in the setting of myocardial infarction or left ventricular assist device implantation, with limited data on these metrics in patients with HFpEF. Objective: The purpose of this study was to determine whether novel RHC parameters such as RA:PCWP and PAPi correlate with long-term renal outcomes among patients with HFpEF. Methods: A retrospective single-center study of adult patients with a documented diagnosis of heart failure who had RHC was performed between January 2006 and December 2010 at Einstein Med ical Center Philadelphia. Selected patients also had a serum B-type natriuretic peptide level ≥100 pg/mL and a PCWP ≥15 mm Hg. Patients with an ejection fraction < 50%, including those with recovered ejection fraction, and end-stage renal disease were excluded. Results: A total of 81 patients with a clinical diagnosis of HFpEF were identified who met the inclusion criteria. On multivariate analysis, after adjusting for age, sex, race, diabetes, hypertension, and cardiac index, PAPi was associated with long-term estimated glomerular filtration rate (eGFR) (β = 3.43, 95% CI = 0.635–6.23, p = 0.017), and RA:PCWP showed a trend towards significance (β = 14.81, 95% CI = –0.096–29.73, p = 0.051). The results were unchanged after further adjustment for eGFR at the time of RHC. Conclusion: Novel hemodynamic indices obtained by RHC may have predictive value for long-term renal dysfunction in patients with HFpEF.

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Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Cited by 51 publications

References 30 publications

Presence of Kidney Disease as an Outcome Predictor in Patients with Pulmonary Arterial Hypertension

Presence of Kidney Disease as an Outcome Predictor in Patients with Pulmonary Arterial Hypertension

Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD

Echocardiographic and Hemodynamic Parameters Associated with Diminishing Renal Filtration among Patients with Heart Failure with Preserved Ejection Fraction

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