Pulmonary Hypertension in Peritoneal Dialysis Patients: Prevalence and Risk Factors

Abstract

Aim To investigate the prevalence of pulmonary arterial hypertension (PAH) and the possible contributing factors for PAH in patients receiving regular continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods The study included 135 CAPD patients and 15 disease-free controls. Patients that had chronic obstructive pulmonary disease, severe mitral or aortic valve disease, connective tissue disease, history of pulmonary embolism, left ventricular ejection fraction <50%, or chest wall or parenchymal lung disease were excluded. All patients and controls were examined using echocardiography and bioelectrical impedance analysis. PAH was defined as systolic pulmonary artery pressure (PAP) >35 mmHg at rest. Results Mean systolic PAP was higher in the CAPD patients than in the controls (19.66 ± 11.66 vs 14.27 ± 4.55 mmHg, p = 0.001). PAH was detected in 17 (12.6%) of the 135 CAPD patients. Mean systolic PAP was significantly higher in patients with PAH than in those without PAH (42.00 ± 9.13 vs 16.44 ± 7.83 mmHg, p = 0.001). Serum albumin level and ejection fraction were lower in patients with PAH than in those without PAH ( p = 0.001 and 0.003 respectively). The ratio of extracellular water/total body water (ECW/TBW), which can reflect hydration status, was significantly higher in patients with PAH than in those without PAH ( p = 0.008). In the PD group, no patients were hypovolemic; 51 (37.8%) of the 135 PD patients were hypervolemic and 84 (62.2%) were normovolemic. Only 3 of the 17 patients with PAH were normovolemic; the rest were hypervolemic. Mean systolic PAP was significantly higher in hypervolemic PD patients (24.57 ± 14.19 mmHg) than in normovolemic PD patients (16.68 ± 7.61 mmHg) ( p = 0.001). PAP correlated with ECW/TBW ( r=0.317, p = 0.001) and left ventricular mass index (LVMI; r=0.286, p = 0.001). On the other hand, it inversely correlated with serum albumin level ( r = –0.281, p = 0.001), hemoglobin level ( r = –0.165, p = 0.044), and ejection fraction ( r = –0.263, p = 0.001). Serum albumin level, ECW/TBW, and LVMI were found in multivariate analysis to be independent risk factors for PAP. Conclusion PAH is a frequent cardiovascular complication in CAPD patients. Serum albumin level, hypervolemia, and LVMI are major risk factors for PAH. Therefore, strategies for treatment of hypervolemia, left ventricular hypertrophy, and hypoalbuminemia should be enhanced to prevent the development of PAH in CAPD patients.

The impact of arteriovenous fistula creation in pulmonary hypertension: Measurement of pulmonary pressures by right heart catheterization in a patient with respiratory failure following arteriovenous fistula creation

“…5 Furthermore, PHT is prevalent in peritoneal dialysis patients as well as in patients dialyzing via tunneled lines. 6,7 On the other hand, it has been suggested that AV fistula placement may play a crucial role in the development of PHT because of increased cardiac output 8 and fistula compression or ligation results in a substantial decrease or even normalization of pulmonary pressures. 4 Currently, there are no data examining the effect of AV fistula in secondary PHT in dialysis patients and AVF remains the optimal mode of dialysis in COPD patients.…”

The long‐term effects of arteriovenous fistula creation on the development of pulmonary hypertension in hemodialysis patients

“…In many studies, the prevalence of pulmonary hypertension was detected in a high ratio of approximately 12% to 45%. [1][2][3][4][5] There are several explanations including high cardiac output resulting from arteriovenous fistula (AVF), anemia, hypervolemia, and pulmonary artery calcifications for pulmonary hypertension in patients with renal disease. [1][2][3]6,7 The aim of this prospective study was to evaluate the long-term effects of AVF, which was created surgically for vascular access, on the development of pulmonary hypertension, and the relationship between blood flow rate of AVF and pulmonary artery pressure (PAP) in patients with endstage renal disease (ESRD).…”

Pulmonary hypertension in patients on chronic hemodialysis and with heart failure

“…MR can be attenuated after intensified ultrafiltration in hemodialysis therapy, 27 and PASP is positively correlated with fluid status. 3 A study conducted by Pabst et al using a right heart catheter in patients on hemodialysis demonstrated reduced pulmonary pressure after ultrafiltration. 4 In the present study, the ratio of IDWG to DW did not differ between the PH and non-PH groups.…”

“…Although pulmonary hypertension (PH) has been proven to be associated with heart failure (HF) in the general population, not until recently has the possible association between PH and end-stage renal disease (ESRD) gained attention. Chronic renal failure on dialysis therapy is listed in the Dana Point classification as a cause of PH 1 ; several mechanisms may explain the relationship between chronic dialysis and PH, such as pulmonary circulation blood flow increment following arteriovenous (AV) access creation, 2 fluid overload, 3,4 and uremic vasculopathy in pulmonary circulation. 5 Being the most frequent cause of PH in the general population, 6,7 left heart problems, including left heart systolic dysfunction, 8,9 left heart diastolic dysfunction, 5,10,11 and left heart valvular disease 12 can be reasonably proposed as playing a critical role in PH in dialysis populations.…”