Pulmonary Hypertension among Patients on Dialysis and Kidney Transplant Recipients

Abstract

Pulmonary arterial hypertension (PAH) is a serious cardiac complication among patients with end-stage renal disease (ESRD). We investigated pulmonary hypertension and its associated factors among patients who were on chronic dialysis and kidney transplant recipients. One hundred-eighty patients in three groups of hemodialysis (HD), peritoneal dialysis (PD), and kidney transplant were studied. Demographic and clinical characteristics and echocardiographic findings were evaluated. A multivariable linear regression model was used to find factors associated with pulmonary artery pressure. The mean age of participants was 50.3 AE 15.5 years and 63.9% were male. We found pulmonary hypertension (mean pulmonary artery pressure >25 mmHg) in 31.6%, 8.3%, and 5% of the patients on HD, PD, and transplant recipients, respectively (p < 0.001). In multivariate analyses, being on HD (B ¼ 5.276, confidence interval [CI] 95%: 1.211-9.341), age (B ¼ -0.319, CI 95%: -0.501 to -0.138), smoking (B ¼ 11.631, CI 95%: 1.847-21.416), systolic cardiac dysfunction (B ¼ 6.313, CI 95%: 3.073-9.554), and diastolic cardiac dysfunction (B ¼ 5.227, CI 95%: 1.176-9.277) were associated with systolic pulmonary artery pressure. These results showed that pulmonary hypertension is a frequent cardiac complication among patients with ESRD, and the type of renal replacement therapy (HD), systolic and diastolic cardiac dysfunction, and smoking are associated with increased pulmonary artery pressure. Further studies with larger sample sizes and also prospective studies are recommended in this regard.

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

“…The definitive treatment for PH in this population is renal transplantation if the etiology is secondary to high cardiac output from AVF. These patients should be considered for renal transplantation as soon as possible 123, 124, 126…”

“…119,122 Treatment of PH Development of PH is associated with significant morbidity and mortality. [121][122][123][124][125] Patients on dialysis with PH have significantly lower survival rates than their counterparts without PH, with respective survival rates of 78.6% versus 96.5% at 1 year, 42.9% versus 78.8% at 3 years, and 25.5% versus 66.4% at 5 years. 126 Thus, patients with ESRD and severe PH should be referred to a PH specialist for PH-specific therapies.…”

“…These patients should be considered for renal transplantation as soon as possible. 123,124,126 Evidence-based guidelines for the perioperative management of patients with PH are lacking because the AHA/ACC practice guidelines for noncardiac surgery do not list PH as an independent risk factor for postoperative complications. 125 Several small studies, however, have suggested that PH is a risk factor for increased peri-and postoperative morbidity and mortality.…”

Reversible pulmonary hypertension in post -renaltransp lantation patient with longst anding arteriovenous fistula

“…Распро страненность ЛГ после успешной трансплантации почки (ТП) существенно ниже: порядка 5-14% [5]. Опубликованы результаты ряда исследований, сви детельствующие о значительном регрессе клинико инструментальных признаков ЛГ после ТП [6][7][8].…”

Pulmonary Hypertension Is Closely Related to Arterial Stiffness in Renal Transplant Patients

“…The prevalence of PH was 5% to 14% among renal transplant patients [6]. There are limited studies that evaluate the causes and frequency of PH and the relationship between cardiac factors in renal transplant patients.…”