Pulmonary Hypertension in Patients With End-Stage Renal Disease

Yigla, Mordechai; Nakhoul, Farid; Sabag, Anat; Tov, Naveh; Gorevich, Bella; Abassi, Zaid; Reisner, Shimon A.

doi:10.1378/chest.123.5.1577

Cited by 270 publications

(339 citation statements)

References 14 publications

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“…Additionally, the prevalence of PHT in the stage 1-4 CKD patients and stage 5 patients was similar. Studies on non-dialysis-dependent stage 5 CKD patients reported that the prevalence of PHT ranges from 9-39% and that the prevalence of PHT is higher in patients undergoing dialysis than in nondialysis patients (9)(10)(11)(12). In the present study the prevalence of PHT in patients with stage 5 CKD not undergoing HD was 58.3%, which is higher than reported earlier (9,11,13,14).…”

Section: Discussioncontrasting

confidence: 63%

“…Studies on non-dialysis-dependent stage 5 CKD patients reported that the prevalence of PHT ranges from 9-39% and that the prevalence of PHT is higher in patients undergoing dialysis than in nondialysis patients (9)(10)(11)(12). In the present study the prevalence of PHT in patients with stage 5 CKD not undergoing HD was 58.3%, which is higher than reported earlier (9,11,13,14). In addition, there weren't any significant differences in sPAP or the prevalence of PHT between the patients undergoing and not undergoing HD.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of Pulmonary Hypertension in Patients with Early Stages of Chronic Renal Disease

Yenigun¹,

Ballı²,

Turgut³

et al. 2016

Med Sci and Discov

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Prevalence of Pulmonary Hypertension in Patients with Early Stages of Chronic Renal Disease

Yenigun¹,

Ballı²,

Turgut³

et al. 2016

Med Sci and Discov

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“…Treatments such as phosphodiesterase type 5 inhibitors or endothelin receptor antagonists have not been studied specifically in patients with ESRD and PH. Surgical reduction of AVF should be considered in patients with very high cardiac output in whom improvements in cardiac output and PH by temporary AVF closure has been shown 121, 122, 126, 127. An AVF flow rate ≥2 L/min and cardiac output of ≥8 L/min place patients at high risk of high‐output cardiac failure 128, 129.…”

Section: Ph In Patients With Esrdmentioning

confidence: 99%

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Bhatti

Galougahi

Paz

et al. 2016

JAHA

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“…In these patients with advanced CKD, PH is prevalent (approximately 30%-40%) and associated with worse outcomes. 2,3 Reflective of poor insight into the nature of PH in this population, individuals with PH and ESRD are included in group 5 PH -that due to cryptic or multifactorial etiologies. The larger population with earlier stages of CKD bears a very high burden of cardiovascular morbidity and mortality; therefore, gaining additional knowledge related to PH in this population is of clinical relevance.…”

mentioning

confidence: 99%

Pulmonary Hypertension in CKD

Sarnak

Roberts

2016

Journal of the American Society of Nephrology

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Pulmonary hypertension (PH), defined as a mean pulmonary artery pressure (mPAP) $25 mmHg, is described in numerous pathologic conditions and its presence is typically associated with worse outcomes. Experts in the field have established a clinical classification system which places patients with PH into five groups according to shared pathobiology, clinical presentation, and therapeutic approaches. 1 Although patients with CKD exhibit many symptoms and risk factors associated with PH, literature describing the epidemiology and impact of PH in CKD has been limited. Until recently, in fact, this literature was limited to CKD stages 4 and 5 with and without dialysis dependency. In these patients with advanced CKD, PH is prevalent (approximately 30%-40%) and associated with worse outcomes. 2,3 Reflective of poor insight into the nature of PH in this population, individuals with PH and ESRD are included in group 5 PH -that due to cryptic or multifactorial etiologies. The larger population with earlier stages of CKD bears a very high burden of cardiovascular morbidity and mortality; therefore, gaining additional knowledge related to PH in this population is of clinical relevance.The current study from Navaneethan et al. leverages the power of the Chronic Renal Insufficiency Cohort (CRIC), a large (n52959) longitudinal cohort study of subjects with eGFR 20-70 ml/min per 1.73 m 2 , providing the most comprehensive description to date of PH prevalence and significance in a nondialysis CKD population. 4 CRIC subjects underwent transthoracic Doppler echocardiography (TTE) interpreted centrally in a core laboratory, as well as detailed ascertainment of covariates and comorbid conditions, and thorough adjudication of cardiovascular and kidney outcomes. The authors used an accepted echocardiographic case definition of PH: pulmonary artery systolic pressure (ePASP) .35 mmHg and/or tricuspid regurgitant velocity .2.5 m/s.Concordant with recent studies from Italy and China, 5,6 PH was prevalent in the CRIC, present in roughly one in five subjects (21%), and was significantly and indirectly related to the eGFR, rising from 6% among CKD stage 1 to 33% in CKD stage 5. As has been described in other studies, PH was associated with older age, systemic hypertension, diabetes, and a history of heart failure (HF). 5,7 Multivariable analysis found that older age, lower hemoglobin, lower left ventricular ejection fraction, and the presence of left ventricular hypertrophy were independently associated with PH. The presence of PH was associated with a 38% increased risk of overall mortality and a 23% increased risk of cardiovascular events (HF, myocardial infarction, cerebrovascular accident, and peripheral vascular disease). In this cohort PH was not associated with progression of CKD.This study has value, not only for the relative novelty of the message that PH is prevalent in all stages of CKD, but additionally for its ability to assess predictors and mortality related to PH using a more systematized approach than prior studies. Despite ...

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Pulmonary Hypertension in Patients With End-Stage Renal Disease

Cited by 270 publications

References 14 publications

Prevalence of Pulmonary Hypertension in Patients with Early Stages of Chronic Renal Disease

Prevalence of Pulmonary Hypertension in Patients with Early Stages of Chronic Renal Disease

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Pulmonary Hypertension in CKD

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