PURPOSE: The incidence of pulmonary hypertension(PAH)in End Stage Renal Disease(ESRD) with or without cardiovascular disease(CVD) has not been particularly studied.The aim of the study was to evaluate the incidence of PAH in patients(pts)with ESRD admitted into the intensive care unit(ICU)with fluid overload.
METHODS: Retrospective chart review on 21 patients with ESRD admitted to the ICU over a 3 year period was done. Only pts with ESRD and evidence of congestion/fluid overload on CXR were selected and 2D echocardiography(ECHO)findings during the admission were analysed.The left ventricular(LV) ejection fraction(EF) was used as a measure of LV systolic function.PAH was defined as systolic pulmonary artery pressure >35mmHg.
RESULTS: The main ECHO findings were LV hypertrophy(LVH)12 of 21(57%),LV systolic dysfunction 11 of 21(52%),PAH 8 of 21(38%), LV diastolic dysfunction 8 of 21(38%),right ventricular hypertrophy 7 of 21(33%),valvular changes 7 of 21(33%),normal biventricular function 4 of 21(19%)and pericardial effusion 3 of 21(14%). Of those with PAH, 4 were males and 3 were females,they were between 43 and 81 years old,no documented HIV positive,no left side valvular abnormality, and no previuos Hx or findings of thromboembolic disease.Length of stay was 3 days(PAH) and 5.1 days(others).Average number of hospital admissions was 8.3(normal echo),16.99(LVH with systolic or diastolic dysfunction)and 21.28(PAH)over the 3 year period.
CONCLUSION: Although most of the ESRD patients with fluid overload had some type of CVD, the most common abnormality being LVH,significant number of pxts(38%) had PAH and 19% unexpectedly had normal biventricular function. PAH group had more hospital admissions compared with other groups. The PAH was not related to hypoxaemia,HIV,thromboembolic disease or left side valvular abnormality.PAH seems to be an independent predictor of mortality in ESRD patients but larger studies would be needed to confirm this finding.
CLINICAL IMPLICATIONS: Echo has a high sensitivity in detecting underlying CVD in patients with ESRD. A relatively high incidence of PAH was found in our group(ESRD with fluid overload). A trial of treatment in this specific group might have changed ontcome.
DISCLOSURE: Adekunle Adekola, None.