Relationship between volume status and possibility of pulmonary hypertension in dialysis naive CKD5 patients

Abstract

Background Chronic fluid overload is common in patients with chronic kidney disease (CKD) and can with time lead to poor prognosis regarding to the cardiovascular events. Serum NT-proBNP and OH/ECW might reflect fluid status of the patients, and the maximal tricuspid regurgitation velocity (TRVmax) could reflect systolic pulmonary artery pressure (SPAP). We investigated the relationship between markers of volume status and marker of pulmonary hypertension (PH) in non-dialysis CKD5 (CKD5-ND) patients. Methods Bioimpedance spectroscopy (BIS), echocardiography, and measurement of serum NT-proBNP were performed in 137 consecutive patients on the same day. TRVmax greater than or equal to 2.9 m/s, corresponding to SPAP of approximately 36 mmHg, was used as a definition of the possibility of PH in the absence of left heart disease and chronic respiratory disease (PH group). Results Patients with possibility of PH (TRVmax ≥ 2.9 m/s) was found in 27 (19.70%) . Among the values obtained from BIS, those reflecting the fluid balance (OH, OH/ECW, and E/I ratio) were significantly higher in the PH group. The OH/ECW in patients with PH were significantly higher than those patients without (26.76 ± 15.07 vs. 13.09 ± 15.05, P < 0.001). NT-proBNP was also significantly higher in PH group compared to the non-PH group (median = 10,112 pg/ml, IQR = 30,847 pg/ml vs. median = 1,973 pg/ml, IQR = 7,093 pg/ml, P < 0.001). OH/ECW was positively associated with TRVmax (r = 0.235, P = 0.006). Multivariate logistic regression revealed that increased OH/ECW and serum NT-proBNP were significantly associated with an increased risk of PH. Conclusions A significant number of patients showed increased TRVmax, which was closely related to volume status in CKD5-ND patients. Echocardiography and BIS could be important players in a high possibility of PH detection and treatment in asymptomatic CKD patients. Therefore, these measures could be helpful to improve the cardiac outcomes after initiating renal replacement therapy. Further research may be needed to validate the consistency of this association across other stages of CKD.

The Prevalence of Pulmonary Hypertension Among Maintenance Dialysis Patients With ESRD and Its Associated Factors: A Retrospective Study

“…Previous studies have reported a relationship between PH and renal dysfunction (4,13). Renal dysfunction is thought to contribute to the development of PH (2).…”

“…Pulmonary hypertension (PH) is reported to be one of the most frequent complications among various diseases including endstage renal disease (ESRD) and is characterized by progressively increased pulmonary arterial pressure (PAP) (1)(2)(3)(4). PH is the leading cause of right heart failure among cardiovascular diseases (1,5,6).…”

“…However, the associated risk factors and precise mechanisms underlying PH in ESRD patients have not been specifically addressed. Some researchers have suggested that the volume overload, severe anemia, hemodynamic modifications, hyperparathyroidism induced by renal failure may be involved in the development of PH (4,10,12,13). Left heart dysfunction in ESRD patients has also been considered to be the underlying cause of PH (14).…”

Reduction of arteriovenous access blood flow leads to biventricular unloading in haemodialysis patients

“…Previous studies [13,14] showed right atrial dilation, increase in pulmonary artery pressure and lowering of longitudinal right ventricular function in haemodialysis patients in comparison with healthy population. The presence of right ventricular (RV) systolic dysfunction [15] and also of pulmonary hypertension [16] were associated with higher all-cause mortality in haemodialysis patients and are strongly influenced by volume overload [17].…”

The significance of volume overload in the development of pulmonary arterial hypertension in continuous ambulatory peritoneal dialysis patients

“…A recent bioimpedance‐based study has demonstrated that hemodialysis patients with PAH had a greater degree of overhydration (OH) [13]. Similarly, BIA indicating the volume status, including OH and OH/extracellular water (ECW) [14], differed considerably between stage 5 chronic kidney disease (CKD) dialysis‐naive patients with PAH and those without it [15].…”