Pulmonary Hypertension Highly Prevalent in Hemodialysis Patients
Pulmonary arterial hypertension (PAH) is a frequent cardiac complication among patients with end-stage renal disease (ESRD), especially among those on hemodialysis, according to Iranian researchers.
A team led by Masoumeh Sadeghi, MD, of Isfahan University of Medical Sciences in Isfahan, studied 60 hemodialysis (HD), 60 peritoneal dialysis (PD), and 60 kidney transplant patients. The researchers identified pulmonary hypertension (defined as pulmonary artery pressure greater than 25 mm Hg while at rest) in 31.6%, 8.3%, and 5% of patients, respectively. In multivariate analyses, HD was independently associated with systolic pulmonary artery pressure, Dr. Sadeghi's group reported online ahead of print in Renal Failure.
The study demonstrated that left ventricular systolic and diastolic dysfunctions are important independent factors associated with PAH, according to the investigators.
The new findings are in line with previous studies showing a significantly higher frequency of PAH in HD than PD patients, Dr. Sadeghi and his colleagues pointed out. Prior research also showed improvement of PAH after kidney transplantation.
“In patients who are at known risk for development of PAH, such as those with pre-existing moderate to severe systolic/diastolic cardiac dysfunction, changing the dialysis type from HD to PD or preparing the patients for transplantation may be a reasonable option to prevent PAH,” the authors wrote. “Strategies for treatment of fluid overload and high cardiac output should be enhanced to prevent the development of PAH in dialysis patients.”