Pulmonary Hypertension Predicts Adverse Outcomes in Renal Patients: A Systematic Review and Meta‐Analysis

Bolignano, Davide; Pisano, Anna; Coppolino, Giuseppe; Tripepi, Giovanni; D’Arrigo, Graziella

doi:10.1111/1744-9987.12777

Cited by 17 publications

(23 citation statements)

References 42 publications

(108 reference statements)

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“…We defined PH as echocardiography reporting an estimated right ventricular systolic pressure (RVSP) ≥35 mmHg and/or a maximum tricuspid regurgitant jet velocity (TRJV) ≥2.9 m/s. This RVSP cutoff was selected because it is commonly reported in the CKD, ESRD, and kidney transplantation literature 9,13,14 . In population studies, higher echocardiogram‐estimated RVSP is positively‐associated with mortality beginning at 33 mmHg 15 .…”

Section: Methodsmentioning

confidence: 99%

Effect of pulmonary hypertension on 5‐year outcome of kidney transplantation

et al. 2022

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Pulmonary hypertension affects about one in four patients with advanced chronic kidney disease and significantly increases the risk of death. Kidney transplantation is the recommended management option for patients with progressive or end‐stage kidney disease. However, the resource‐limited nature of kidney transplantation and its intensive peri‐operative and posttransplantation management motivates careful consideration of potential candidates’ medical conditions to optimally utilize available graft organs. Since pulmonary hypertension is known to increase peri‐operative morbidity and mortality among patients living with chronic kidney disease, we performed a retrospective cohort study to assess the impact of pretransplantation pulmonary hypertension on posttransplantation outcome. All patients who underwent single‐organ kidney transplantation at our center in calendar years 2010 and 2011 were identified and the presence of pulmonary hypertension was determined from pretransplantation echocardiography. Outcome was assessed at 5 years following kidney transplantation. Of 350 patients who were included, 117 (33%) had evidence of pulmonary hypertension. The risk of death, graft dysfunction, or graft failure at 5 years after kidney transplantation was higher among those with pulmonary hypertension, primarily owing to an increased risk of graft dysfunction. Importantly, in this institutional cohort of kidney transplant recipients, pretransplant pulmonary hypertension was not associated with a difference in posttransplant survival at 5 years. While institutional and regional differences in outcome can be expected, this report suggests that carefully selected patients with pulmonary hypertension receive similar long‐term benefits from kidney transplantation.

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Section: Methodsmentioning

confidence: 99%

Effect of pulmonary hypertension on 5‐year outcome of kidney transplantation

et al. 2022

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“…1). In a recent meta-analysis of observational studies (Bolignano et al, 2018) PH had an overall pooled prevalence of 33% (95% CI 28-42) that resulted lower in CKD (30%; 95% CI 13-47) than in dialysis (35%; 95% CI 28-42) populations. Hence, the overall estimated frequency of this condition was about 3-times higher than that reported in the general population.…”

Section: Epidemiological Significance Of Ph In the General And Renal mentioning

confidence: 99%

“…This starts from various observations on high risk chronic hemodialysis cohorts (Yigla et al, 2003(Yigla et al, , 2009Agarwal, 2012;Ramasubbu et al, 2010) that have subsequently been extended also to pre-dialysis CKD populations (Bolignano et al, 2015). A very recent meta-analysis (Bolignano et al, 2018) collected data from 18 outcome studies (10740 participants) focusing on individuals with various degree of renal function impairment who were stratified according to the presence or absence of PH. Overall, PH conveyed a significantly higher risk of all-cause mortality (RR 2.08; 95% CI 1.06-4.08), a finding that was more evident in individuals on ESKD in chronic renal replacement therapy than in those with early renal impairment (RR 1.90; 95% CI 1.61-2.25).…”

Section: Prognostic Significance Of Ph In the General Population And mentioning

confidence: 99%

“…Recently, evidence has accumulated indicating that pauci-or non-symptomatic PH is remarkably prevalent also in CKD persons, particularly in ESKD patients on chronic dialysis (Bolignano et al, 2013). This may have relevant clinical value as the presence of PH in CKD is generally associated with increased mortality, CV events and even delayed graft function in renal transplanted patients (Bolignano et al, 2015(Bolignano et al, , 2018. Screening of pulmonary pressure might therefore represent an additional, helpful tool for risk stratification of renal patients and targeting overt PH, whenever present, may translate into additional benefits also in the CKD setting.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary hypertension: a neglected risk condition in renal patients?

Bolignano,

Pisano,

D’Arrigo

2018

Rev. Cardiovasc. Med.

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Pulmonary hypertension (PH), an acknowledged risk condition at the community level and in patients with heart or lung diseases, is now getting growing attention as a new, potentially modifiable cardiovascular (CV) risk factor also in individuals affected by kidney diseases. PH is highly prevalent in this setting, being about 3 to 6 times more frequent that in the general population and portends a risk excess for mortality, adverse CV outcomes and also worsen graft function in kidney transplant recipients. Several factors might be involved to explain PH in renal patients, including but not limited to volume overload, breath disorders, left heart dysfunction and the presence of highflow artero-venous fistulas. Targeting PH might lead to improved outcomes in renal patients but the lack of specific interventional studies and the need for more accurate evidence adopting standardized ways to assess PH leave the issue open for future research.

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“…Much of the literature and clinical effort regarding preoperative risk stratification in this population focuses on ischemic heart disease and left-sided heart fail- ure [1,2]. The prevalence of pulmonary hypertension (PH) in ESRD has been reported to be about 33% [4], based on echocardiographic evidence of elevated right ventricular systolic pressure (RVSP). While elevated pretransplant RVSP has been associated with the adverse posttransplant outcomes in a number of studies [5], data regarding the impact of right ventricular (RV) failure on postoperative outcomes remain limited [1,6].…”

Section: Introductionmentioning

confidence: 99%

Right Ventricular Dysfunction and Adverse Outcomes after Renal Transplantation

et al. 2021

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Introduction: Pulmonary hypertension is common among patients with end-stage renal disease, although data regarding the impact of right ventricular (RV) failure on postoperative outcomes remain limited. We hypothesized that echocardiographic findings of RV dilation and dysfunction are associated with adverse clinical outcomes after renal transplant. Methods: A retrospective review of adult renal transplant recipients at a single institution from January 2008 to June 2010 was conducted. Patients with transthoracic echocardiograms (TTEs) within 1 year leading up to transplant were included. The primary end point was a composite of delayed graft function, graft failure, and all-cause mortality. Results: Eighty patients were included. Mean follow-up time was 9.4 ± 0.8 years. Eight patients (100%) with qualitative RV dysfunction met the primary end point, while 39/65 patients (60.0%) without RV dysfunction met the end point (p = 0.026). Qualitative RV dilation was associated with a significantly shorter time to all-cause graft failure (p = 0.03) and death (p = 0.048). RV systolic pressure was not measurable in 45/80 patients (56%) and was not associated with outcomes in the remaining patients. Conclusion: RV dilation and dysfunction are associated with adverse outcomes after renal transplant. TTE assessment of RV size and function should be a standard part of the pre-kidney transplant cardiovascular risk assessment.

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Pulmonary Hypertension Predicts Adverse Outcomes in Renal Patients: A Systematic Review and Meta‐Analysis

Cited by 17 publications

References 42 publications

Effect of pulmonary hypertension on 5‐year outcome of kidney transplantation

Effect of pulmonary hypertension on 5‐year outcome of kidney transplantation

Pulmonary hypertension: a neglected risk condition in renal patients?

Right Ventricular Dysfunction and Adverse Outcomes after Renal Transplantation

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