Pulmonary Hypertension Linked With Worse Prognosis in CKD, ESRD
Risks were highest for kidney failure patients on dialysis.
Pulmonary hypertension may increase the risks for cardiovascular events and death in patients with any degree of kidney disease, according to new study findings.
In a systematic review and meta-analysis of 16 studies including 7112 patients with chronic kidney disease (CKD) or kidney failure, 23% had co-existing pulmonary hypertension diagnosed by Doppler echocardiography. The presence of pulmonary hypertension, compared with its absence, was associated with 1.4-, 2.3-, and 2.1-fold higher risks for all-cause mortality among patients with CKD, end-stage renal disease (ESRD) receiving dialysis, or a functioning kidney transplant, respectively, Mengyao Tang, MD, MPH, of Harvard T.H. Chan School of Public Health in Boston, and colleagues reported in the American Journal of Kidney Diseases. The risks were similar for patients receiving hemodialysis or peritoneal dialysis. The cutoff value used to diagnose pulmonary hypertension did not alter results.
Pulmonary hypertension also was associated with more than double the risk for cardiovascular mortality in patients with CKD or ESRD. The risks for cardiovascular events were 1.7- and 2.3-fold higher in patients with CKD and ESRD receiving dialysis, respectively. The definition of cardiovascular events varied across studies, but generally included acute heart failure, myocardial infarction, stroke, and peripheral vascular disease.
“Better understanding of the underlying risks and mechanisms of pulmonary hypertension in CKD and ESRD, combined with randomized studies evaluating the efficacy of pulmonary hypertension therapies, may stand to improve clinical outcomes in this vulnerable population," Dr Tang and the team stated.
Among other possibilities, pulmonary hypertension might serve as a surrogate for cardiac dysfunction or volume overload, according to the authors.
Tang M, Batty JA, Lin C, Fan X, Chan KE, and Kalim S. Pulmonary hypertension, mortality, and cardiovascular disease in CKD and ESRD patients: A Systematic Review and Meta-analysis. Am J Kidney Dis. doi: 10.1053/j.ajkd.2017.11.018