PURPOSE: Chronic kidney disease (CKD) and end stage renal disease (ESRD) are independent markers of cardiovascular morbidity and mortality. However, the prevalence of pulmonary hypertension (PH) in this group of patients is not very well known. Our purpose was assessment of the prevalence of PH in patients with ESRD on Hemodialysis (HD) as measured by right heart catheterization, and comparing them with patients who have CKD as well as patients with a normal glomerular filtration rate (GFR).
METHODS: Data from 83 consecutive right heart catheterizations performed over a period of 10 months was analyzed retrospectively. PH was defined as a mean pulmonary artery pressure (MPAP) of greater than 25. For patients not on hemodialysis, the GFR was calculated using the Cockroft-Gault equation. The patients were divided into the end-stage renal disease group (ESRD), the chronic kidney disease group (CKD) (defined as a GFR< 60ml/min) and patients with normal GFR. The prevalence of PH was compared in each of the 3 individual groups using the Fisher exact test and analysis of variance. Clinical and demographic variables were compared between the 3 groups.
RESULTS: PH was found in 39 out of 83 patients. Of these, 11 were patients with ESRD, 14 with CKD and 14 had normal GFR. Prevalence of PH in patients with CKD or ESRD did not differ significantly from patients with normal GFR. A non-parametric linear regression plot on all patients revealed that collectively, as the BMI increased so did the MPAP, but not significantly (p =0.0985). However, among all patients with a BMI > 30, a subgroup comparison of patients with either CKD or ESRD with patients with normal GFR revealed a statistically significant (p=0.014) increase in MPAP as the BMI increased.
CONCLUSION: Renal dysfunction and obesity are individually, not associated with PH. However, in coexistence, obesity and renal dysfunction could be possible associates of PH.
CLINICAL IMPLICATIONS: More stringent assessment for PH is warranted in a subset of the obese population that also has renal dysfunction.
DISCLOSURE: Humaira Adenwalla, None.