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

Zhang, Ying; Ding, Xiaoyan; Rao, Rongsheng; Wang, Yiqin; Pang, Fang; Tang, Sha; Nie, Lei; Bian, Shizhu

doi:10.3389/fmed.2020.570874

Cited by 13 publications

(20 citation statements)

References 33 publications

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“…Kalpana S Mehta et al showed that the prevalence of PH increased as chronic kidney disease stage advanced, and there was a positive correlation between PH and duration of chronic kidney disease, BUN and serum creatinine (23). Zhang et al showed similar results, in which PH was significantly associated with end-stage renal disease, however, the level of BUN and creatinine were not associated with PH (24). Unlike their reports, renal failure was not associated with mortality in PPH patients in our study (Table 6), which might be because the secondary PH caused by renal injury has a completely different mechanism from the renal injury caused by PPH.…”

Section: Discussionmentioning

confidence: 93%

Novel Prognostic Predictor for Primary Pulmonary Hypertension: Focus on Blood Urea Nitrogen

Jin

et al. 2021

Front. Cardiovasc. Med.

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Background: Primary pulmonary hypertension (PPH) is a life-threatening disease associated with increased mortality. The urea cycle pathway plays a major role in PPH severity and treatment response. Little is known about the association of the blood urea nitrogen (BUN) and PPH prognosis.Methods: Clinical data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Adult patients (≥18 years) patients with primary pulmonary hypertension (PPH) in the database were enrolled. Spearman correlation was used to analyze the association of BUN with length of hospital and intensive care unit (ICU) stays. The chi-square test was used to analyze the association of BUN with mortality rate. Survival curves were estimated using the Kaplan-Meier method and compared by the log-rank test. Multivariable logistic regression was used to identify the BUN as an independent prognostic factor of mortality. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to analyze the sensitivity and specificity for mortality.Results: In total, 263 patients who met the selection criteria were enrolled. BUN was significantly positively associated with length of hospital stay and ICU stay (hospital stay: ρ = 0.282, ICU stay: ρ = 0.276; all P < 0.001). Higher hospital, 90-day and 4-year mortality rates were observed in the higher BUN quartile of PPH patients (hospital: P = 0.002; 90-day: P = 0.025; 4-year: P < 0.001). The Kaplan-Meier survival curves showed that patients in higher BUN quartile tended to have lower 4-year survival (Q1:7.65%, Q2: 10.71%; Q3: 14.80%, Q4: 16.84%; P < 0.0001). Logistic regression analyses found a significant association of BUN and mortality (hospital: OR = 1.05, 95% CI = 1.02–1.08, P = 0.001; 90-day: OR = 1.02, 95% CI = 1.00–1.05, P = 0.027; 4-year: OR = 1.05, 95% CI = 1.02–1.08, P = 0.001). Results of ROC and AUC showed that the diagnostic performance of BUN for mortality was moderately good.Conclusion: BUN was positively correlated with the length of hospital stay and ICU stay of PPH patients. Higher BUN was associated with higher hospital, 90-day and 4-year mortality and lower 4-year survival of PPH patients. These findings indicate that BUN can be a novel potential prognostic predictor for PPH.

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Section: Discussionmentioning

confidence: 93%

Novel Prognostic Predictor for Primary Pulmonary Hypertension: Focus on Blood Urea Nitrogen

Jin

et al. 2021

Front. Cardiovasc. Med.

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“…Additionally, the toxicity of metabolic wastes contributes to PH following renal failure. Blood components and electrolytes have also been associated with PH, which may be attributed to their roles in vascular remodeling via vascular endothelial cells and vascular smooth muscle cells (Zhang et al, 2016(Zhang et al, , 2020b. The apoptosis-related markers Fas and Fas ligand (FasL) have also been reported to be a higher level in the ESRD patients compared with others (Perianayagam et al, 2000).…”

Section: Resultsmentioning

confidence: 99%

“…Pulmonary hypertension (PH) has been identified as one of the most common cardiovascular complications associated with various diseases, including cardiovascular diseases and chronic kidney diseases, and particularly in end-stage renal disease ( Barbera et al, 2018 ; Gumus and Saricaoglu, 2020 ; Walther et al, 2020 ; Zhang et al, 2020b ). PH is characterized with a progressive elevation of pulmonary arterial pressure (PAP; Olschewski et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Baseline Ratio of Soluble Fas/FasL Predicts Onset of Pulmonary Hypertension in Elder Patients Undergoing Maintenance Hemodialysis: A Prospective Cohort Study

et al. 2022

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BackgroundPulmonary hypertension (PH) is one of the most common complications associated with end-stage renal disease (ESRD). Though numerous risk factors have been founded, other risk factors remain unidentified, particularly in patients undergoing maintenance hemodialysis with elder age. Soluble Fas (sFas) and its ligand FasL (sFasL) have been reported in chronic renal disease patients; however, they have not been identified in the PH patients of elder hemodialysis patients. We aimed to determine the roles of sFas/sFasL in onset of PH in elder patients undergoing maintenance hemodialysis with ESRD.MethodsAltogether, 163 patients aged 68.00 ± 10.51 years with ESRD who undergoing maintenance hemodialysis in a prospective cohort and were followed-up for a median of 5.5 years. They underwent echocardiography examinations, liver function assessments, residual renal function, and serum ion examinations, before and after dialysis. Furthermore, levels of sFas and sFasL at baseline had also been measured. We compared demographic data, echocardiographic parameters, liver function, ions, and residual renal function as well as serum sFas and sFasL between the PH and non-PH groups. These parameters were correlated with systolic pulmonary artery pressure (sPAP) using Spearman’s correlation. Moreover, univariate and adjusted logistic regression analyses have also been conducted.ResultsThe incidence of PH in the elder dialysis patients was 39.1%. PH populations were demonstrated with significantly higher end-diastolic internal diameters of the left atrium, left ventricle, right ventricle (RV), and pulmonary artery, as well as the left ventricular posterior wall thickness (LVWP; all p < 0.05). A higher baseline serum sFas and sFasL levels have also been identified ( p < 0.001). They also showed lower fractional shortening and left ventricular ejection fraction (LVEF; p < 0.05). Following dialysis, the post-dialysis serum potassium concentration (K+) was significantly higher in the PH group ( p = 0.013). Furthermore, the adjusted regression identified that ratio of sFas/FasL (OR: 1.587, p = 0.004), RV (OR: 1.184, p = 0.014), LVPW (OR: 1.517, p = 0.007), and post-dialysis K+ (OR: 2.717, p = 0.040) was the independent risk factors for PH while LVEF (OR: 0.875, p = 0.040) protects patients from PH.ConclusionThe baseline ratio of sFas/sFasL, RV, LVPW, and post-dialysis K+ was independent risk factors for PH onset, while LVEF was a protective factor for PH.

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“…Despite the fact that these studies used different criteria and are not truly equivalent, the majority of them found a greater prevalence of PH in HD patients. 2 , 5 , 6 , 8 , 9 …”

Section: Discussionmentioning

confidence: 99%

“…None of the laboratory risk factors like anemia, serum calcium, phosphorus, albumin, PTH, and ferritin were found to be significantly associated with PH which is similar to previous studies. 8 , 9 …”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Pulmonary Hypertension in Patients on Hemodialysis: A Single Center Study

Nagaraju¹,

Bhojaraja²,

Paramasivam³

et al. 2021

IJNRD

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Introduction Pulmonary hypertension (PH) is an underestimated cardiovascular consequence and a mortality predictor in patients on hemodialysis (HD). Thus, we studied its prevalence, risk factors, association with inflammation/oxidative stress, and cardiac changes in HD patients. Methods This was a single-center cross-sectional observational study conducted at a tertiary care hospital. Patients aged >18 years on hemodialysis for at least three months were included and divided into those with and without PH; patients with secondary causes for PH were excluded. Clinical characteristics, HD-related factors, lab parameters (C-reactive protein and malondialdehyde with thiol assay were used as markers of inflammation and oxidative stress, respectively), and echocardiography details were compared. PH was defined as a mean pulmonary artery pressure of >25 mmHg at rest, and it was further divided as mild (25–40 mmHg), moderate (40–60 mmHg), and severe (>60 mmHg). Results Of 52 patients, 28 patients had PH (mild 24, moderate 4, and none had severe PH) with prevalence of 54%. No difference was found in clinical characteristics, dialysis-related factors, biochemical parameters including inflammation (C-reactive protein; p =0.76), or oxidative stress (thiol; p =0.36 and MDA; p =0.46) between the groups. When compared to individuals without PH, HD patients with PH exhibited significantly more mitral regurgitation ( p =0.002). Conclusion Hemodialysis patients have a high prevalence of PH. PH was significantly associated with the presence of mitral regurgitation on echocardiography. Our study did not find differences in traditional risk factors, HD-related factors, and inflammation/oxidative markers between the groups with and without PH.

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

Cited by 13 publications

References 33 publications

Novel Prognostic Predictor for Primary Pulmonary Hypertension: Focus on Blood Urea Nitrogen

Novel Prognostic Predictor for Primary Pulmonary Hypertension: Focus on Blood Urea Nitrogen

Baseline Ratio of Soluble Fas/FasL Predicts Onset of Pulmonary Hypertension in Elder Patients Undergoing Maintenance Hemodialysis: A Prospective Cohort Study

Risk Factors of Pulmonary Hypertension in Patients on Hemodialysis: A Single Center Study

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