Pulmonary Hypertension in CKD

Bolignano, Davide; Rastelli, Stefania; Agarwal, Rajiv; Fliser, Danilo; Massy, Ziad A.; Ortíz, Alberto; Wiȩcek, Andrzej; Martínez‐Castelao, Alberto; Covic, Adrian; Goldsmith, David; Süleymanlar, Gültekin; Lindholm, Bengt; Parati, Gianfranco; Sicari, Rosa; Gargani, Luna; Mallamaci, Francesca; London, Gérard M.; Zoccali, Carmine

doi:10.1053/j.ajkd.2012.07.029

Cited by 130 publications

(123 citation statements)

References 67 publications

(66 reference statements)

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…The need for substantial increases in pulmonary blood flow related to increased CO, coupled with demonstrable increases in LV mass and left atrial dilatation, provides a mechanistic cardiac contribution to previous observations of elevated pulmonary arterial pressure in the ESRF context. 29 Furthermore, it is conceivable that AVF-creation may be associated with endothelial dysfunction in the pulmonary vascular bed, as seen peripherally in our study. The combination of alterations in cardiac structure and function associated with AVF-creation demonstrated in this study and the possible contribution of pulmonary vascular endothelial dysfunction could contribute to the increase in pulmonary arterial pressure in ESRF, with resultant clinical implications.…”

mentioning

confidence: 68%

The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study

Dundon¹,

Torpey²,

Nelson³

et al. 2014

IJNRD

View full text Add to dashboard Cite

Aim: Arteriovenous fistula-formation remains critical for the provision of hemodialysis in endstage renal failure patients. Its creation results in a significant increase in cardiac output, with resultant alterations in cardiac stroke volume, systemic blood flow, and vascular resistance. The impact of fistula-formation on cardiac and vascular structure and function has not yet been evaluated via "gold standard" imaging techniques in the modern era of end-stage renal failure care. Methods: A total of 24 patients with stage 5 chronic kidney disease undergoing fistula-creation were studied in a single-arm pilot study. Cardiovascular magnetic resonance imaging was undertaken at baseline, and prior to and 6 months following fistula-creation. This gold standard imaging modality was used to evaluate, via standard brachial flow-mediated techniques, cardiac structure and function, aortic distensibility, and endothelial function. , and left ventricular mass were observed (12.7% increase) (P,0.01). Endothelial-dependent vasodilation was significantly decreased at follow up (9.0%±9% vs 3.0%±6%) (P=0.01). No significant change in aortic distensibility was identified. Conclusion:In patients with end-stage renal failure, fistula-formation is associated with an increase in cardiac output, dilation of all cardiac chambers and deterioration in endothelial function.

show abstract

mentioning

confidence: 68%

The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study

Dundon¹,

Torpey²,

Nelson³

et al. 2014

IJNRD

View full text Add to dashboard Cite

show abstract

“…Recent systematic reviews studying PH in the kidney disease population highlighted several other studies addressing the higher prevalence and consequences of PH in both hemodialysis and peritoneal dialysis populations (21)(22)(23). These reviews highlighted the lack of data relating to prevalence and effects of PH in those patients with nondialysis-dependent CKD (22).…”

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

View full text Add to dashboard Cite

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.

show abstract

“…In recent years, pulmonary hypertension (PH) in chronic kidney disease (CKD) patients is gaining interest because of its apparent high prevalence and its significant role in the outcome, principally in patients undergoing hemodialysis (HD) [1][2][3] . This condition usually remains asymptomatic and sometimes is misdiagnosed over a period of time until right ventricular dysfunction begins to manifest by worsening fatigue, dyspnea and syncope [4] .…”

Section: Introductionmentioning

confidence: 99%

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

Reque

García‐Prieto²,

Liñares³

et al. 2016

Am J Nephrol

View full text Add to dashboard Cite

Background: We evaluated the prevalence, determinants and prognosis value of pulmonary hypertension (PH) in non-dialysis chronic kidney disease (CKD) patients. Methods: This is a prospective study with stages 3-5 non-dialysis-dependent CKD patients. PH was estimated by Doppler echocardiography and defined as a pulmonary artery systolic pressure above 35 mm Hg. Results: Three hundred fifty-three patients were recruited, of whom 94 (26.6%) had PH. Prevalence of PH increased with the decline of renal function: 21.6, 24.1, and 31.7% in stages 3, 4, and 5, respectively. Independent predictors of PH were age, estimated glomerular filtration rate (eGFR), history of cardiovascular (CV) events, the presence of an arteriovenous fistulae (AVF), and left ventricular (systolic and diastolic) dysfunction. Over a median follow-up of 22 months, 71 patients died (20%). After multivariate adjustment for age, gender, previous CV disease, diastolic and systolic dysfunction, PH remained as an independent predictor of all-cause mortality (hazards ratio [HR] 1.84, 95% CI 1.06-3.18, p = 0.02). One hundred patients (28%) had a new onset CV event. After adjustment for age, gender, previous CV disease, systolic and diastolic dysfunction, PH maintains its independent association with CV events (HR 2.77, 95% CI 2.00-3.25, p < 0.001). Conclusions: PH prevalence rises as kidney function declines. Main determinants of PH are age, eGFR, previous CV disease, the presence of an AVF and left ventricular systolic or diastolic dysfunction. PH is an independent predictor of all-cause mortality and CV events.

show abstract

Pulmonary Hypertension in CKD

Cited by 130 publications

References 67 publications

The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study

The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

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

Contact Info

Product

Resources

About