Pulmonary Hypertension in Chronic Renal Failure Patients

Abdelwhab, Saeed; Elshinnawy, Samah

doi:10.1159/000146076

Cited by 93 publications

(100 citation statements)

References 71 publications

(46 reference statements)

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“…Although not confirmed by our results and some other studies, 6,19 current evidence is in favor of a role of AVF presence, duration, and blood flow in the pathogenesis of PAH in patients on dialysis. 3,11,20,21 Another factor that can contribute to the development of PAH by increasing cardiac output is anemia, 5,7,10,18 which was confirmed by our univariate but not multivariate analyses probably due to the small sample size. The relationship between hypoalbuminemia and sPAP, which is reported by some studies and found in our study as well, 7,10 is another factor that is probably a consequence of hypervolemia.…”

Section: Underlying Mechanisms For Pahsupporting

confidence: 57%

“…Some studies showed an association of calcium Â phosphate product with sPAP, 20,22 and we found such association in transplant recipients; however, there are other reports against this result. 3,8,10,21,23 Other risk factors introduced by some of the previous studies are age 3,6,21 and smoking 3,22 for which the exact mechanisms are not yet clear. In our study, multivariate analyses showed an inverse association of age with sPAP, which might be related to lower age in transplant recipients in whom the frequency of PAH was very low.…”

Section: Underlying Mechanisms For Pahmentioning

confidence: 99%

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Pulmonary Hypertension among Patients on Dialysis and Kidney Transplant Recipients

et al. 2013

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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.

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Section: Underlying Mechanisms For Pahsupporting

confidence: 57%

Section: Underlying Mechanisms For Pahmentioning

confidence: 99%

Pulmonary Hypertension among Patients on Dialysis and Kidney Transplant Recipients

et al. 2013

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“…In CKD, higher PAP was noted in those patients with higher PCWP. In addition, previous studies have speculated on the potential influence of uremic toxins, bone-mineral disorder, and endothelial dysfunction on outcomes among those PH patients who are on dialysis (23,27,28). Particularly, these reports note that nitric oxide levels are reduced along with an attenuated release of nitric oxide in those patients on hemodialysis with PH.…”

Section: Discussionmentioning

confidence: 99%

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Navaneethan

Wehbe

Heresi³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Pulmonary hypertension is associated with higher mortality rates. The associations of nondialysis-dependent CKD and all-cause mortality in patients with pulmonary hypertension were studied.Design, setting, participants, & measurements The study population included those patients who underwent right heart catheterization for confirmation of pulmonary hypertension between 1996 and January 2011. Pulmonary hypertension was defined as the presence of mean pulmonary artery pressure$25 mmHg at rest measured by right heart catheterization. CKD was defined as the presence of two measurements of eGFR,60 ml/min per 1.73 m 2 90 days apart. The risk factors associated with CKD as well as the association between CKD and death in those patients with pulmonary hypertension using logistic regression and Cox proportional hazard models were examined.Results Of 1088 patients with pulmonary hypertension, 388 (36%) patients had CKD: 340 patients had stage 3 CKD, and 48 (4%) patients had stage 4 CKD. In the multivariable analysis, older age, higher hemoglobin, and higher mean right atrial pressures were independently associated with CKD. During a median follow-up of 3.2 years (interquartile range=1.5-5.6 years), 559 patients died. After adjusting for relevant covariates, presence of stage 3 CKD (hazard ratio, 1.37; 95% confidence interval, 1.14 to 1.66) and stage 4 CKD (hazard ratio, 2.69; 95% confidence interval, 1.88 to 3.86) was associated with all-cause mortality in those patients with pulmonary hypertension. When eGFR was examined as a continuous measure, a 5 ml/min per 1.73 m 2 lower eGFR was associated with a 5% (95% confidence interval, 1.03 to 1.07) higher hazard for death. This higher risk with CKD was similar irrespective of demographics, left ventricular function, and pulmonary capillary wedge pressure. ConclusionIn a clinical population referred for right heart catheterization, presence of CKD was associated with higher all-cause mortality in those patients with pulmonary hypertension. Mechanisms that may underlie these associations warrant additional studies.

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“…The prevalence of PH ranges from 9-39% in predialysis patients with stage-5 CKD (Yigla et al, 2003;Buemi et al, 2007;Havlucu et al, 2007;Abdelwhab and Elshinnawy, 2008;Issa et al, 2008), 18.8-68.8% in hemodialysis patients, and 0-42% in individuals on peritoneal dialysis therapy (Kumbar et al, 2007;Bozbas et al, 2009;Unal et al, 2009;Casas-Aparicio et al, 2010;Kiykim et al, 2010;Fabbian et al, 2011;Agarwal, 2012;Etemadi et al, 2012). In our study, 37 of 128 (28.91%) CKD patients from China, who accepted no dialysis or renal transplantation, had Doppler-derived PASP ≥ 35 mmHg.…”

Section: Discussionmentioning

confidence: 55%

“…PH in patients with CKD may be induced and/or aggravated by left ventricular (LV) disorders as well as the presence of risk factors typical to CKD, including volume overload, an arteriovenous fistula (Abdelwhab and Elshinnawy, 2008), sleep-disordered breathing (Sakaguchi et al, 2011), exposure to dialysis membranes (Kiykim et al, 2010), endothelial dysfunction (Zoccali, 2007), vascular calcification and stiffening, and severe anemia (Buemi et al, 2007). Preventing PH in this population is crucial, as even kidney transplantation may not reverse the high mortality associated with PH.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary hypertension in patients with stage 1-3 chronic kidney disease

Yang

Bao

2014

Genet. Mol. Res.

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ABSTRACT. Pulmonary hypertension (PH) secondary to chronic kidney disease (CKD) is common, but in stages 1-3 CKD patients, it remains unclear. We sought to evaluate the prevalence of PH and elucidate the possible pathogenesis in Chinese patients with early stage kidney disease. Doppler-estimated pulmonary systolic artery pressure (PASP) was measured in 101 CKD patients with glomerular filtration rate (GFR) ≥60 mL/min/1.73 m 2 and 27 CKD patients with GFR < 60 mL/min/1.73 m 2 . Echocardiographic parameters, plasma brain natriuretic peptide (BNP), and baseline characteristics of patients were recorded. PH was defined as a PASP ≥ 35 mmHg. PH prevalence was 23.76% (24/101) in GFR ≥ 60 mL/min/1.73 m 2 group and 48.15% (13/27) in GFR < 60 mL/min/1.73 m 2 group, P < 0.05. Mean lnBNP was 4.93 ± 1.60 pg/mL in 37 cases with PH and 2.89 ± 1.29 pg/mL in those without, P < 0.01. Left atrial diameter (LA) showed deviation between patients with (43.94 ± 5.81 mm) and without PH (37.76 ± 7.48 mm), P < 0.01. GFR declined significantly in PH group (44.10 ± 22.90 mL/ min/1.73 m 2 ) compared to non-PH group (75.59 ± 31.62 mL/min/1.73 m 2 ), P < 0.01. lnBNP, LA and GFR were independent determinants (r = 0.651, 0.595, -0.488, P < 0.01) of PASP. PH is prevalent among stage 1-3 CKD patients in China. Doppler-estimated PASP is strongly associated with lnBNP, enlarged LA and GFR. Monitoring PASP, plasma BNP and evaluation renal function may help to detect and

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Pulmonary Hypertension in Chronic Renal Failure Patients

Cited by 93 publications

References 71 publications

Pulmonary Hypertension among Patients on Dialysis and Kidney Transplant Recipients

Pulmonary Hypertension among Patients on Dialysis and Kidney Transplant Recipients

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Pulmonary hypertension in patients with stage 1-3 chronic kidney disease

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