Pulmonary hypertension (PH) is associated with increased risks for kidney failure, hospitalizations, and mortality among older adults with chronic kidney disease (CKD), a new study finds.
In a study of Medicare patients with CKD aged 67 to 95 years (57.8% female; 10.3% Black), investigators compared 30,052 with PH (based on claims data) with 150,260 without PH who were matched by CKD stage.
In an adjusted model, the presence of PH compared with its absence was associated with significant 2.2- and 1.2-fold increased risks for end-stage kidney disease (ESKD) at 1 and 2-3 years, respectively, but not after 4-5 years of follow-up, Sankar D. Navaneethan, MD, MS, MPH, of Baylor College of Medicine in Houston, Texas, and colleagues reported in the American Journal of Kidney Diseases. The investigators noted that greater proportions of patients with than without PH experienced acute kidney injury (AKI) at 1 year (40% vs 13%), 2-3 years (36% vs 20%), and 4-5 years (33% vs 19%). The PH group also had higher rates of AKI requiring dialysis support within 30 days (2.8%, 2.5%, and 1.8%) and 90 days (3.0%, 2.6%, and 1.9%) during these respective years. For the group without PH, rates of AKI requiring dialysis ranged lower, from 0.7% to 1.2%.
PH also was associated with higher rates of all-cause, cardiovascular (CV), and non-CV hospitalization compared with no PH, especially at 1 year, Dr Navaneethan and his colleagues reported. The hazard ratios for CV hospitalization (4.6, 1.8, and 1.6) were generally higher than the hazard ratios for non-CV hospitalization (2.6, 1.4, and 1.3) at 1, 2-3, and 4-5 years, respectively.
The presence of PH compared with its absence was significantly associated with approximately 2.9, 1.6, and 1.5 times higher risk for all-cause mortality at 1, 2-3, and 4-5 years, respectively.
For older adults with PH and CKD, risks for kidney failure, hospitalization, and death were the highest at year 1, then tended to decline, the investigators noted.
These results coincide with prior studies that mostly included younger CKD populations aged less than 65 years.
“Prevalence of PH increased with increasing age, and older adults have a higher comorbidity burden that places them at higher risk of sustaining adverse outcomes,” Dr Navaneethan’s team stated. “Our data suggest the need to identify PH earlier on among high-risk older adults to facilitate the adoption of therapeutic interventions and make necessary referrals to PH centers for further management.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Navaneethan SD, Walther CP, Gregg LP, Bansal S, Winkelmayer WC, Nambi V, Niu J. Mortality, kidney failure, and hospitalization among Medicare beneficiaries with CKD and pulmonary hypertension. Am J Kidney Dis. Published online April 23, 2021. doi:10.1053/j.ajkd.2021.02.336