Pulmonary hypertension associates with malnutrition and body composition hemodialysis patients

Abstract

Background/Aim: The prevalence of pulmonary hypertension (PH) is reported between 17 and 56% in hemodialysis (HD) patients. Pathogenesis of PH in HD patients is still unclear. Malnutrition associating impaired pulmonary function tests in HD patients previously reported. Present study aimed to investigate an association between PH and nutrition and inflammation HD patients. Patients/Methods: Total 179 HD patients (109 M, 70 F) were included. Pulmonary artery pressure (PAP) and ejection fraction (EF) percentage was determined by echocardiography after a midweek HD session. Bioimpedance analyses were performed after dialysis. Percent body fat mass truncal fat (%), total body water (%), body-mass index was determined. Serum 25-OH vitamin D, albumin, lipid parameters, C-reactive protein (CRP), calcium, phosphorus, parathyroid hormone, ferritin levels, and hemogram were studied. Results: Pulmonary hypertension (PAP 435 mmHg) was found in 48 (26.8%) of 179 patients studied. Body-mass index (BMI) was negatively correlated with PAP (r ¼ À0.34; p ¼ 0.02). HD vintage, prevalence of diabetes, sex, type of vascular access were not different between patients with PH and without PH. Patients with PH were older (68.1 ± 14.4; 61.3 ± 14.7; p ¼ 0.005). Percent body fat (19.8 ± 8.1% vs. 28.1 ± 10%; p ¼ 0.001), albumin (3.4 ± 0.5 g/dl vs. 3.9 ± 3.3 g/dl; p ¼ 0.0001), truncal fat (16.8 ± 10.7 vs. 26.4 ± 10.5; p ¼ 0.001), triglyceride (147.9 ± 88.5 vs. 182.1 ± 97.7 mg/dl; p ¼ 0.03), and total cholesterol (146.9 ± 34.5 vs. 169.5 ± 43 mg/dl; p ¼ 0.004) levels were significantly lower in patients with PH than with no PH. Logistic regression analysis revealed that increased percent body fat, albumin, and total cholesterol associate with a decreased risk of PH. Conclusion: Present study demonstrated a significant association between malnutrition and PH in HD patients. Those results should be confirmed by further prospective studies including cytokine levels and spirometric measurements.

Total, Bioavailable, and Free Vitamin D Levels and Their Prognostic Value in Pulmonary Arterial Hypertension

“…This is consistent with the concept that vitD itself or its metabolites do not regulate DBP production [19,38]. Previous studies also reported lower serum albumin concentrations in PAH patients [39,40] and in PAH animal models [41], suggesting that reduced albumin may be a risk factor for PAH. Following the formulas given above, calculated free 25(OH)vitD is inversely related to DBP and albumin concentrations.…”

Association of Pulmonary Hypertension With Inflammatory Markers and Volume Status in Hemodialysis Patients of End-Stage Renal Disease

“…Thus, AV fistula can contribute to the development of PH. Pulmonary hypertension has been shown to be associated with AV fistula by some authors [5,19] but others have shown no association [17,20]. This study too does not show any association between PH and AV fistula.…”

The breath print represents a novel biomarker of malnutrition in pulmonary arterial hypertension: A proof of concept study

“…39 Nutrition status has also been shown to be associated with disease severity. 21,40 The causes of malnutrition in PAH are multifactorial and include reduced appetite and food intake, malabsorption of nutrients, increased energy expenditure, and elevated catabolism. However, it is unclear which precise metabolic…”

“…Patients with PAH frequently present with cachexia, the result of progressive malnutrition 39 . Nutrition status has also been shown to be associated with disease severity 21,40 . The causes of malnutrition in PAH are multifactorial and include reduced appetite and food intake, malabsorption of nutrients, increased energy expenditure, and elevated catabolism.…”