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J Am Soc Nephrol. 2016 Mar;27(3):877-86. doi: 10.1681/ASN.2014111111. Epub 2015 Sep 18.

Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD.

Author information

  • 1Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas; sankar.navaneethan@bcm.edu.
  • 2Department of Biostatistics and Epidemiology.
  • 3Division of Nephrology, University of Illinois, Chicago, Illinois;
  • 4Division of Nephrology, Tulane University School of Medicine, New Orleans, Louisiana;
  • 5Division of Cardiovascular Medicine, and.
  • 6Divisions of Nephrology and.
  • 7Division of Nephrology, University of Michigan, Ann Arbor, Michigan;
  • 8Division of Nephrology, George Washington University, Washington, DC;
  • 9Pulmonary Critical Care and Sleep Medicine, Wayne State University, Detroit, Michigan;
  • 10Department of Nephrology, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; and.
  • 11Division of Nephrology and Hypertension, St. John Hospital and Medical Center, Detroit, Michigan.
  • 12Renal, Electrolyte and Hypertension Division at Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
  • 13Department of Pulmonary and Critical Care Medicine at the Respiratory Institute, Cleveland Clinic, Cleveland, Ohio;

Abstract

Pulmonary hypertension (PH) is associated with poor outcomes in the dialysis and general populations, but its effect in CKD is unclear. We evaluated the prevalence and predictors of PH measures and their associations with long-term clinical outcomes in patients with nondialysis-dependent CKD. Chronic Renal Insufficiency Cohort (CRIC) Study participants who had Doppler echocardiography performed were considered for inclusion. PH was defined as the presence of estimated pulmonary artery systolic pressure (PASP) >35 mmHg and/or tricuspid regurgitant velocity (TRV) >2.5 m/s. Associations between PH, PASP, and TRV and cardiovascular events, renal events, and all-cause mortality were examined using Cox proportional hazards models. Of 2959 eligible participants, 21% (n=625) had PH, with higher rates among those with lower levels of kidney function. In the multivariate model, older age, anemia, lower left ventricular ejection fraction, and presence of left ventricular hypertrophy were associated with greater odds of having PH. After adjusting for relevant confounding variables, PH was independently associated with higher risk for death (hazard ratio, 1.38; 95% confidence interval, 1.10 to 1.72) and cardiovascular events (hazard ratio, 1.23; 95% confidence interval, 1.00 to 1.52) but not renal events. Similarly, TRV and PASP were associated with death and cardiovascular events but not renal events. In this study of patients with CKD and preserved left ventricular systolic function, we report a high prevalence of PH. PH and higher TRV and PASP (echocardiographic measures of PH) are associated with adverse outcomes in CKD. Future studies may explain the mechanisms that underlie these findings.

Copyright © 2016 by the American Society of Nephrology.

KEYWORDS:

CKD; heart failure; mortality; pulmonary hypertension

PMID:
26386072
[PubMed - in process]
PMCID:
PMC4769189
[Available on 2017-03-01]
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