PURPOSE: There is increasing evidence that prevalence of pulmonary hypertension (PH) is high among patients with chronic kidney disease (CKD). Past reviews have observed prevalence ranging from 18 to 51.6%. Elevated cardiac output secondary to arterio-venous access has been postulated to be playing a major role in underlying mechanism although data is conflicting. There is limited evidence suggesting in significant decrease in PAP after renal transplantation in these patients.
METHODS: Records of 117 patients with CKD who underwent renal transplantation were reviewed retrospectively. Information collected included their echocardiogram findings prior to initiation of renal replacement therapy (RRT), prior to and post renal transplantation. Pulmonary hypertension was defined as pulmonary artery systolic pressure (PAP) > 35 mm Hg.
RESULTS: Observed prevalence of PH was 30.8% (overall), 18 % (peritoneal dialysis), 32.6 % (hemodialysis) and 36.8 % (patients with AV Fistula/Graft). No statistical difference in prevalence was observed between patients who were on RRT and those who were not (p = 0.48) and between patients who had AV fistula/graft compared to peritoneal dialysis or patients not on RRT. (p = 0.14) There were no significant differences between patients with PH and those without PH with regards race, age, body mass index, sex, smoking or etiology of CKD except atrial fibrillation which was more common in PH group. (p = 0.048). No significant difference was observed in PAP before and after renal transplantation in the PH group. Mean difference -1.79 (p = 0.65).
CONCLUSION: This study demonstrates a high prevalence (30.8 %) of PH among patients with CKD consistent with past observations. No significant effect of AV fistula or graft on prevalence or severity of PH was observed. No significant decrease in PAP was observed after renal transplantation on PAP at 22 month follow up.
CLINICAL IMPLICATIONS: This study is a first of its kind that evaluates prevalence of pulmonary hypertension in US population with CKD prior to receiving renal transplant and the impact of renal transplantation on their pulmonary artery pressure.
DISCLOSURE: Adarsh Sahni, No Financial Disclosure Information; No Product/Research Disclosure Information