Association of Pulmonary Hypertension With Inflammatory Markers and Volume Status in Hemodialysis Patients of End-Stage Renal Disease

Abstract

Background and objectives Pulmonary hypertension (PH) is an independent risk factor for increased mortality, especially in patients undergoing hemodialysis (HD), but the mechanism of its development is unknown. This study aimed at evaluating volume overload and inflammation as potential variables to cause its development in patients undergoing maintenance hemodialysis. Materials and methods This was an observational cross-sectional study conducted on patients undergoing hemodialysis at a tertiary hospital in northern India. Patients of end-stage renal disease, aged 18 years or more, on maintenance hemodialysis for over two months were included in the study. The patients were divided into two groups based on the presence or absence of PH, determined by measuring systolic pulmonary arterial pressure (SPAP). The severity of PH was defined as: mild (SPAP 35-45 mmHg), moderate (SPAP 46-55 mmHg), and severe (SPAP> 55mmHg). The two groups were evaluated for demographic variables, type of vascular access, biochemical parameters, and markers of inflammation and fluid overload. Data between the two groups were compared statistically. Results This study included a total of 82 patients showing the prevalence of PH to be 25.6% with a men-to-women ratio of 2:1. Out of 21 cases of PH, mild PH was found in seven (33.3%) cases, moderate in 14 (66.7%), and cases with severe PH were none. The two groups differed significantly in ejection fraction and markers of inflammation and volume status. Laboratory data associated with PH were alpha-1-acid glycoprotein (p<0.05) and pro-b-type natriuretic peptide (p <0.05). Conclusion The present study showed higher levels of inflammatory markers alpha-1-acid glycoprotein and pro-b-type natriuretic peptide and lower levels of ejection fraction in patients undergoing HD, indicating a significant association with PH.

Risk Factors of Pulmonary Hypertension in Patients on Hemodialysis: A Single Center Study

“…This study did not reveal any significant association with inflammation (CRP levels) and oxidative stress (MDA and thiol assay) in our hemodialysis patients. This is unlike the recent study by Sonkar et al (n=82) 7 wherein a higher level of inflammatory marker (alpha-1-acid glycoprotein) was seen in HD patients with PH. Another study by Smukowska-Gorynia et al 24 revealed higher levels of MDA in patients with PH but it included non-CKD and non-HD-dependent patients.…”

“…However, the role of oxidative stress and inflammation in the development of PH is yet to be fully established. 7 …”

Frequency of Pulmonary Hypertension and Its Associated Risk Factors in End-Stage Renal Disease (ESRD) Patients on Maintenance Hemodialysis

“…In their study, compared to normotensive patients, hypertensive patients were 3.2 times more likely to have PH (95% CI: 2.91-3.53; p < 0.001)[15]. These results are similar to studies done by Suresh et al[1], Tudoran et al[7], and Sonkar et al[14], which showed hypertension as a prevalent comorbidity in ESRD patients, which may have a role in the development of PH.The severity of PH was substantially correlated with the echocardiographic findings of RWMA, LVH, and LVEF. In our study, the prevalence of RWMA was higher in patients with mild PH (74.55%), moderate PH (80.6%), and severe PH (88.9%).…”

Nghiên Cứu Tỷ Lệ Và Các Yếu Tố Liên Quan Đến Tăng Áp Động Mạch Phổi Trên Bệnh Nhân Lọc Máu Định Kỳ Tại Bệnh Viện Đa Khoa Vĩnh Long Năm 2023

“…So sánh với các công trình nghiên cứu về tỷ lệ TAĐMP trên bệnh nhân LMĐK Thiếu máu, tăng cân giữa 2 lần lọc máu, rối loạn chức năng tâm thu và tâm trương của tim. Sonkar [12] Ấn Độ 43,48±14,65 82 25,6 Yếu tố viêm tăng, EF giảm CO: cung lượng tim, EF: phân suất tống máu.…”