SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters III
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Prevalence of pulmonary hypertension (PH) in end stage renal disease (ESRD) has been reported to be 30-60%. The prevalence of renal dysfunction in PH is not known. One study on PH patients hospitalized with right heart failure, reported moderate-severe chronic kidney disease (CKD) in 67%. The prevalence of renal dysfunction in patients with pulmonary arterial Hypertension (PAH) has not been studied. The objective of this study was to determine the prevalence of renal dysfunction in patients with PAH and its impact on survival.
METHODS: Records of patients with PAH being followed at our institution were reviewed. Right heart catheterization (RHC) data at initial evaluation (mPA, PVR, PCWP) was obtained. Only patients with mPA> 25mmHg and PCWP <15mmHg were included. Patient demographics, weight, height, BUN and serum creatinine (S.Cr) at initial evaluation were extracted. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault formula: CrCl = (140-age) X (Wt in kg) X (0.85 if female) / (72 X S.Cr). CrCl was used as an estimate of glomerular filtration rate (GFR) in ml/min. Number of patients on dialysis and number who expired during 3-to-5 years of follow-up was noted. Linear regression analysis was performed to determine the correlation of BUN, S.Cr and CrCl with survival. p< 0.05 was deemed statistically significant.
RESULTS: Of 75 patients, 76% were women; mean age was: 64 ± 14 years; mean weight 74 ±19kg. All patients had significant PH, with mean mPAP of 42 ± 13 mmHg; mean PVR of 573± 384 dynes/sec/cm5. Mean BUN was 17.3 ± 9mg%; mean S Cr was 1 ±0.4mg%; mean CrCl was 34.2 ±14ml/min. Eighty-four percent had moderate--severe renal disease with CrCl<60ml/min. One patient was on hemodialysis; 29% expired during period of follow-up. On linear regression, BUN ( p=0.06), S.Cr (p=0.15) and CrCl (p=0.11) did not have a significant effect on mortality.
CONCLUSIONS: Majority of PAH patients have significant renal dysfunction based on CrCl (estimated by the Cockcroft-Gault formula) but this did not affect survival. Potential inaccuracies due to the non-steady state of S.Cr may underestimate renal function based on calculated CrCl.
CLINICAL IMPLICATIONS: Further studies on renal dysfunction in PAH by more accurate methods of estimating GFR are needed.
DISCLOSURE: The following authors have nothing to disclose: Julianne Nichols, Raymond Foley, D. Datta
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