Kidney dysfunction in patients with pulmonary arterial hypertension

Abstract

Pulmonary arterial hypertension (PH) and chronic kidney disease (CKD) both profoundly impact patient outcomes, whether as primary disease states or as co-morbid conditions. PH is a common co-morbidity in CKD and vice versa. A growing body of literature describes the epidemiology of PH secondary to chronic kidney disease and end-stage renal disease (ESRD) (WHO group 5 PH). But, there are only limited data on the epidemiology of kidney disease in group 1 PH (pulmonary arterial hypertension [PAH]). The purpose of this review is to summarize the current data on epidemiology and discuss potential disease mechanisms and management implications of kidney dysfunction in PAH. Kidney dysfunction, determined by serum creatinine or estimated glomerular filtration rate, is a frequent co-morbidity in PAH and impaired kidney function is a strong and independent predictor of mortality. Potential mechanisms of PAH affecting the kidneys are increased venous congestion, decreased cardiac output, and neurohormonal activation. On a molecular level, increased TGF-β signaling and increased levels of circulating cytokines could have the potential to worsen kidney function. Nephrotoxicity does not seem to be a common side effect of PAH-targeted therapy. Treatment implications for kidney disease in PAH include glycemic control, lifestyle modification, and potentially Renin-Angiotensin-Aldosterone System (RAAS) blockade.

Primary cardiac hospitalizations in pulmonary arterial hypertension: Trends and outcomes from 2001 to 2014

“…systemic lupus erythematous, scleroderma, etc. ), codes for end-stage renal disease were not removed [18,19]. To allow for evaluation of co-existing PAH and cardiac disease, diagnostic codes for WHO Group 2 PH were also not removed.…”

Clinical Features and Risk Factors of Pulmonary Hypertension in Chinese Patients With Systemic Lupus Erythematosus

“…26 As a common comorbidity and independent risk factor for poor outcome in SLE, the damage is intensified by PH. 27 Impaired renal function and increased NT-proBNP are indicative that the right heart function is affected. Certain researchers believed that deterioration of these factors is related to the progression of cardiopulmonary involvement resulting from PH.…”

Hipertensão pulmonar em pacientes com doença renal crônica terminal internados em um hospital de referência em nefrologia do estado do Pará, Brasil

“…A HAP é uma doença cuja fisiopatologia envolve diversas condições clínicas e pode ser um fator complicador para a maioria das doenças cardiovasculares e respiratórias 4 . São tidos como prováveis mecanismos, pelos quais a HAP se relaciona com a DRC, a congestão venosa, a diminuição do débito cardíaco e a ativação neuro-hormonal, além do aumento da sinalização de TGF-β e dos níveis de citocinas circulantes 14 .…”

“…Em 2016, um estudo analisou as tendências relacionadas à HAP em adultos, nos Estados Unidos, e demonstrou que a hipertensão arterial (5,1-17,1%), a diabetes (4,6-7,8%) e a doença coronariana (15,6-22,3%) são comorbidades frequentemente associadas. A insuficiência cardíaca congestiva (40,7-56,1%) e a doença renal aguda (5,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20),1%) e crônica (1,1-16,4%) também aparecem como fatores importantes 22 .…”