Incidence, Correlates, and Consequences of Acute Kidney Injury in Patients With Pulmonary Arterial Hypertension Hospitalized With Acute Right-Side Heart Failure

Haddad, François; Fuh, Eric; Peterson, T.W.; Skhiri, Mehdi; Kudelko, Kristina; Perez, Vinicio de Jesus; Winkelmayer, Wolfgang C.; Doyle, Ramona L.; Chertow, Glenn M.; Zamanian, Roham T.

doi:10.1016/j.cardfail.2011.03.003

Cited by 49 publications

(41 citation statements)

References 35 publications

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“…However, we chose to focus on a specific intervention (RRT) for an acute complication (AKI) for patients with evidence of decompensation of a rare condition (PH due to PAH or inoperable CTEPH), which explains the relatively small numbers of patients that could be identified for study. Indeed, Campo et al [6] identified only 3 patients who underwent RRT among 90 PAH patients displaying acute heart failure over a 9-year study period, and Haddad et al [7] identified 5 of such patients over a 10-year study period, further emphasizing the difficulty in studying this patient subgroup. Nevertheless, although rare, AKI in PH patients is a very challenging situation carrying an important prognostic significance.…”

Section: Discussionmentioning

confidence: 99%

“…PH patients may experience severe acute RV failure that may be related to disease progression itself or to an acute intercurrent illness during the course of their disease [2]. There are very limited evidence-based data regarding the management of acute RV failure in PH patients, with, to our knowledge, only four cohort studies to date [3,4,5,6,7]. Acute kidney injury (AKI) is frequently observed as a complication during such episodes and its prognostic significance has recently been highlighted [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…There are very limited evidence-based data regarding the management of acute RV failure in PH patients, with, to our knowledge, only four cohort studies to date [3,4,5,6,7]. Acute kidney injury (AKI) is frequently observed as a complication during such episodes and its prognostic significance has recently been highlighted [4,6,7]. The precise pathophysiological pathways leading to decreased kidney function in PH remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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Renal Replacement Therapy in Patients with Severe Precapillary Pulmonary Hypertension with Acute Right Heart Failure

Sztrymf¹,

Prat

Jacobs

et al. 2012

Respiration

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Background: Renal replacement therapy has been suggested as a therapeutic option in the setting of acute right ventricular failure in patients with severe precapillary pulmonary hypertension. However, there are few data supporting this strategy. Objectives: To describe the clinical course and the prognosis of pulmonary hypertensive patients undergoing renal replacement therapy in the setting of acute right heart failure. Methods: This was a single-center retrospective study over an 11-year period. Data were collected from all patients with chronic precapillary pulmonary hypertension requiring catecholamine infusions for clinical worsening and acute kidney injury that necessitated renal replacement therapy. Results: Fourteen patients were included. At admission, patients had a blood urea of 28.2 mmol/l (22.3-41.2), a creatinine level of 496 µmol/l (304-590), and a mean urine output in the 24 h preceding hospitalization of 200 ml (0-650). Sixty-eight renal replacement therapy sessions were performed, 36 of which were continuous and 32 of which were intermittent. Systemic hypotension occurred in 16/32 intermittent and 16/36 continuous sessions (p = 0.9). Two patients died during a continuous session. The intensive care unit-related, 1-, and 3-month mortality was 46.7, 66.7, and 73.3%, respectively. Conclusion: Renal replacement therapy is feasible in the setting of acute right ventricular failure in patients with severe precapillary pulmonary hypertension but is associated with a poor prognosis. The best modality and timing in this population remain to be defined.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Renal Replacement Therapy in Patients with Severe Precapillary Pulmonary Hypertension with Acute Right Heart Failure

Sztrymf¹,

Prat

Jacobs

et al. 2012

Respiration

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“…Several factors lead to the development and worsening of PH, and kidney dysfunction and volume overload are common occurrences in clinical practice that can lead to increased pulmonary artery pressure (PAP) (3,4). This decline in kidney function could be transiently related to hemodynamic changes during the treatment of volume overload associated with PH (5). These hemodynamic changes could lead to CKD if the insults are persistent or the underlying disease continues to worsen.…”

Section: Introductionmentioning

confidence: 99%

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Navaneethan

Wehbe

Heresi³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Pulmonary hypertension is associated with higher mortality rates. The associations of nondialysis-dependent CKD and all-cause mortality in patients with pulmonary hypertension were studied.Design, setting, participants, & measurements The study population included those patients who underwent right heart catheterization for confirmation of pulmonary hypertension between 1996 and January 2011. Pulmonary hypertension was defined as the presence of mean pulmonary artery pressure$25 mmHg at rest measured by right heart catheterization. CKD was defined as the presence of two measurements of eGFR,60 ml/min per 1.73 m 2 90 days apart. The risk factors associated with CKD as well as the association between CKD and death in those patients with pulmonary hypertension using logistic regression and Cox proportional hazard models were examined.Results Of 1088 patients with pulmonary hypertension, 388 (36%) patients had CKD: 340 patients had stage 3 CKD, and 48 (4%) patients had stage 4 CKD. In the multivariable analysis, older age, higher hemoglobin, and higher mean right atrial pressures were independently associated with CKD. During a median follow-up of 3.2 years (interquartile range=1.5-5.6 years), 559 patients died. After adjusting for relevant covariates, presence of stage 3 CKD (hazard ratio, 1.37; 95% confidence interval, 1.14 to 1.66) and stage 4 CKD (hazard ratio, 2.69; 95% confidence interval, 1.88 to 3.86) was associated with all-cause mortality in those patients with pulmonary hypertension. When eGFR was examined as a continuous measure, a 5 ml/min per 1.73 m 2 lower eGFR was associated with a 5% (95% confidence interval, 1.03 to 1.07) higher hazard for death. This higher risk with CKD was similar irrespective of demographics, left ventricular function, and pulmonary capillary wedge pressure. ConclusionIn a clinical population referred for right heart catheterization, presence of CKD was associated with higher all-cause mortality in those patients with pulmonary hypertension. Mechanisms that may underlie these associations warrant additional studies.

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“…The effect of high blood pressure on the remodeling of myocardium and direct impact of these hemodynamic changes on kidney vasculature could contribute to the increased risk of AKI in patients with OSA. Increase in venous pressure and kidney congestion on the one hand, and hypertensive nephropathy, on the other hand, would make kidney vulnerable to acute injuries [21,47] . Nevertheless, it is certainly plausible that the observed association, while potentially true, is not causal.…”

Section: Discussionmentioning

confidence: 99%

Association between Obstructive Sleep Apnea and Acute Kidney Injury in Critically Ill Patients: A Propensity-Matched Study

Dou

Lan

Reynolds

et al. 2016

Nephron

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Background/Aims: Obstructive sleep apnea (OSA) is a known risk factor for chronic kidney disease (CKD); however, its association with acute kidney injury (AKI) is not well documented. We aimed to study whether OSA is associated with the risk of AKI in the intensive care unit (ICU) setting. Methods: All consecutive adult Olmsted County, MN residents who were admitted in Mayo Clinic ICUs from January 1, 2010 to December 31, 2010 were screened. Chronic and acute risk factors were collected within the first 48 h of ICU admission. Logistic regression and propensity score matching were used to examine crude and adjusted associations of OSA with AKI. Results: Among 1,259 enrolled ICU patients, 183 patients had a diagnosis of OSA prior to the index ICU admission. Compared with non-OSA patients, the incidence of AKI in OSA patients was more frequent (41 vs. 57%, p < 0.001). In univariate analysis, it was found that CKD, age, gender, Caucasian race, congestive heart failure, cerebrovascular disease, diabetes mellitus, body mass index, and OSA were associated with AKI. In the multivariate model, following adjustment for age, gender, race, and chronic and acute risk factors, OSA was found to have an independent association with AKI (OR 1.53; 95% CI 1.04-2.24; p = 0.031). Among 176 propensity score matched pairs, there was a significant difference in the incidence of AKI between the OSA and non-OSA groups (OR 1.54; 95% CI 1.01-2.35; p = 0.04). Conclusions: The history of OSA diagnosed by polysomnography is associated with higher risk of AKI in critically ill patients.

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Incidence, Correlates, and Consequences of Acute Kidney Injury in Patients With Pulmonary Arterial Hypertension Hospitalized With Acute Right-Side Heart Failure

Cited by 49 publications

References 35 publications

Renal Replacement Therapy in Patients with Severe Precapillary Pulmonary Hypertension with Acute Right Heart Failure

Renal Replacement Therapy in Patients with Severe Precapillary Pulmonary Hypertension with Acute Right Heart Failure

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Association between Obstructive Sleep Apnea and Acute Kidney Injury in Critically Ill Patients: A Propensity-Matched Study

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