Prevalence of Pulmonary Hypertension in Patients with Early Stages of Chronic Renal Disease

Abstract

Aim: Pulmonary hypertension (PHT) was recently described as a cardiovascular complication of chronic kidney disease (CKD). There are many studies on the prevalence of PHT in patients undergoing hemodialysis (HD); however, there are no data on the presence or prevalence of PHT in patients with early-stage kidney disease.

Materials and Methods: The demographic and laboratory findings for 172 adult patients with stage 1-5 CKD, as well as Doppler echocardiographic findings were evaluated. Systolic pulmonary arterial pressure (sPAP) was compared according to CKD stage, and also between the patients in stages 1-4 and those in stage 5 with and without AVF.

Results: Mean age of the patients was 55.4 ± 15.2 years. Mean sPAP in the entire study group was 34.5 ± 5.7 mmHg and PHT was noted in 90 (52.3 %) patients. Mean sPAP and the prevalence of PHT were similar in the stage 1-4 patients and stage 5 patients, regardless of HD (P=0.86). The serum calcium level was significantly lower and the serum intact parathyroid hormone level was significantly higher in patients with PHT than in those without PHT (P = 0.02, and P = 0.03).

Conclusion: The present findings show that the prevalence of PHT in patients with early stage CKD was similar to those with stage 5 CKD. Due to the high morbidity and mortality rates associated with PHT, follow-up of sPAP via Doppler echocardiography might be indicated in all patients with CKD.

Keywords

• chronic kidney disease; pulmonary hypertension; prevalance

Medical Science and Discovery

Öz

References

1. Martin KB, Klinger JR, Rounds SI. Pulmonary arterial hypertension: new insights and new hope. Respirology 2006; 11(1): 6–17.
2. Yigla M, Dabbah S, Azzam ZS, et al. Background diseases in 671 patients with moderate to severe pulmonary hypertension. Isr Med Assoc J 2000; 2: 684–689.
3. Galiè N, Hoeper MM, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009; 30(20): 2493-2537.
4. Bolignano D, Rastelli S, Agarwal R, et al. Pulmonary Hypertension in CKD. Am J Kidney Dis 2013; 61: 612-622.
5. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter 2013; 3: 1–150.
6. Levey AS, Coresh J, Greene T, et al. Chronic Kidney Disease Epidemiology Collaboration. Expressing the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate with Standardized Serum Creatinine Values. Clin Chem 2007; 53: 766-772.
7. Berger M, Haimowitz A, Van Tosh P, et al. Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol 1985; 6: 359.
8. Rosenkranz S. Pulmonary hypertension: current diagnosis and treatment. Clin Res Cardiol 2007; 96: 527–541.

9. Yigla M, Nakhoul F, Sabag A, et al. Pulmonary hypertension in patients with end-stage renal disease. Chest 2003; 123: 1577-1588.
10. Tarrass F, Benjelloun M, Medkouri G, et al. Doppler echocardiograph evaluation of pulmonary hypertension in patients undergoing hemodialysis. Hemodial Int 2006; 10(4): 356-359.
11. Havlucu Y, Kursat S, Ekmekci C, et al. Pulmonary hypertension in patients with chronic renal failure. Respiration 2007; 74(5): 503-510.
12. Nakhoul F, Yigla M, Gilman R, et al. The pathogenesis of pulmonary hypertension in haemodialysis patients via arteriovenous access. Nephrol Dial Transplant 2005; 20(8): 1686-1692.
13. Yigla M, Fruchter O, Aharonson D, et al. Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Int 2009; 75(9): 969-975.
14. Issa N, Krowka MJ, Griffin MD, et al. Pulmonary hypertension is associated with reduced patient survival after kidney transplantation. Transplantation 2008; 86: 1384-1388.
15. Badesch DB, Champion HC, Sanchez MA, et al. Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2009; 54: 55-66.
16. Fruchter O, Yigla M. Underlying aetiology of pulmonary hypertension in 191 patients: A single centre experience. Respirology 2008; 13: 825–831.
17. Arese M, Strasly M, Ruva C, et al. Regulation of nitric oxide synthesis in uraemia. Nephrol Dial Transplant 1995; 10(8): 1386–1397.
18. Stefanidis I, Wurth P, Mertens PR, et al. Plasma endothelin-1 in hemodialysis treatment - the influence of hypertension. J Cardiovasc Pharmacol 2004; 44: 43–48.
19. Odetti P, Monacelli F, Storace D, et al. Correlation between pentosidine and endothelin-1 in subjects undergoing chronic hemodialysis. Horm Metab Res 2006; 38(12): 817–820.
20. Buemi M, Senatore M, Gallo GC, et al. Pulmonary hypertension and erythropoietin. Kidney Blood Press Res 2007; 30(4): 248–252.
21. Milliner DS, Zinsmeister AR, Lieberman E, Landing B. Soft tissue calcification in pediatric patients with end-stage renal disease. Kidney Int 1990; 38(5): 931–936.
22. Ifudu O. Care of patients undergoing hemodialysis. N Engl J Med 1998; 339: 1054–1062.
23. Yigla M, Abassi Z, Reisner SA, Nakhoul F. Pulmonary Hypertension in Hemodialysis Patients: An Unrecognized Threat. Seminars in Dialys 2006; 19: 353–357.
24. Pabst S, Hammerstingl C, Hundt F, et al. Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-study. PLoS One 2012;7(4): e35310.
25. Unal A, Tasdemir K, Oymak, et al. The long-term effects of arteriovenous fistula creation on the development of pulmonary hypertension in hemodialysis patients. Hemodial Int 2010; 14: 398-402.
26. Fisher MR, Forfia PR, Chamera E, et al. Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med 2009; 179(7): 615-621.
27. Unal A, Sipahioglu M, Oguz F, et al. Pulmonary hypertension in peritoneal dialysis patients: prevalence and risk factors. Perit Dial Int 2009; 29: 191-198.
28. Bozbas SS, Akcay S, Altin C, et al. Pulmonary Hypertension in Patients With End-Stage Renal Disease Undergoing Renal Transplantation. Transplant Proc 2009; 41(7): 2753-2756.
29. Davies MR, Hruska KA. Pathophysiological mechanisms of vascular calcification in end-stage renal disease. Kidney Int 2001; 60: 472–479.
30. Amin M, Fawzy A, Hamid MA, Elhendy A. Pulmonary hypertension in patients with chronic renal failure: role of parathyroid hormone and pulmonary artery calcifications. Chest 2003; 124: 2093–2097.
31. Yigla M, Keidar Z, Safadi I, et al. Pulmonary calcification in hemodialysis patients: correlation with pulmonary artery pressure values. Kidney Int 2004: 66; 806-810.
32. Akmal M, Barndt RR, Ansari AN, et al. Excess PTH in CRF induces pulmonary calcification, pulmonary hypertension and right ventricular hypertrophy. Kidney Int 1995; 47(1): 158–163.
33. Kumbar L, Fein PA, Rafiq MA, et al. Pulmonary hypertension in peritoneal dialysis patients. Adv Perit Dial 2007; 23: 127–131.