Risk factors for pulmonary hypertension in patients receiving maintenance peritoneal dialysis

Abstract

We investigated the risk factors for pulmonary hypertension (PH) in patients receiving maintenance peritoneal dialysis (MPD). A group of 180 end-stage renal disease patients (124 men and 56 women; mean age: 56.43±8.36) were enrolled in our study, which was conducted between January 2009 and June 2014. All of the patients received MPD treatment in the Dialysis Center of the Second Affiliated Hospital of Soochow University. Clinical data, laboratory indices, and echocardiographic data from these patients were collected, and follow-ups were scheduled bi-monthly. The incidence and relevant risk factors of PH were analyzed. The differences in measurement data were compared by t-test and enumeration data were compared with the χ2 test. Among the 180 patients receiving MPD, 60 were diagnosed with PH. The remaining 120 were regarded as the non-PH group. Significant differences were observed in the clinical data, laboratory indices, and echocardiographic data between the PH and non-PH patients (all P<0.05). Furthermore, hypertensive nephropathy patients on MPD showed a significantly higher incidence of PH compared with non-hypertensive nephropathy patients (P<0.05). Logistic regression analysis showed that the proportion of internal arteriovenous fistula, C-reactive protein levels, and ejection fraction were the highest risk factors for PH in patients receiving MPD. Our study shows that there is a high incidence of PH in patients receiving MPD and hypertensive nephropathy patients have an increased susceptibility to PH.

The Problem of Pulmonary Artery Hypertension in End-Stage Renal Disease: Can Peritoneal Dialysis be the Solution

“…Using meta-analysis, the pooled prevalence estimates of PAH were similar to the median prevalence estimates but had high statistical heterogeneity. The difference in pooled prevalence among those receiving HD versus PD was signi cant (Chi-squared 27.53, df 1, p < 0.00001) (33). In our study the prevalence of PAH (24.2%) was more or less in line with those reported in previous studies (34)(35)(36).…”

“…This is of signi cant interest and importance due to the large numbers of ESRD patients (in 2016 there were more than 700,000 patients with ESRD in the US alone, with prevalence increasing by approximately 20,000 per year) (32) Many researchers have studied PAH in ESRD on hemodialysis but few studies (only 11) have investigated the same with PD as stated in a recent metanalysis (33). The sPAP used to diagnose PAH varied among studies; the most common threshold was an sPAP > 35 mmHg but ranged from > 30 mmHg to > 45 mmHg (33). Compared with hemodialysis (HD), the prevalence of PAH was much less in ESRD patients receiving treatment with PD.…”

“…However, visual inspection of the Forest Plots suggested that the heterogeneity may be attributable to there being three categories of studies, those reporting low, moderate, and high prevalence of PAH. When the three categories of studies were pooled separately, the heterogeneity nearly disappeared (33). Studies from the Middle East and North Africa (34-38) had a pooled prevalence among patients undergoing any type of dialysis of 38% (95% CI 30-45%), among patients receiving HD of 42% (95% CI 35-50%), and among patients receiving PD of 15% (95% CI 9-21%).…”

Changes in pulmonary artery systolic pressure and right ventricular function in patients with end‐stage renal disease on maintenance dialysis

“…2,4 Peritoneal dialysis (PD) patients also appear to have a high prevalence of PH. 5 The pathophysiology of PH in patients with end-stage renal disease (ESRD) is not known. Many possible reasons for the development of PH in this population have been proposed and studied, with conflicting results, including imbalance between vasoconstrictors and vasodilators, 6 mineral and bone disorders (MBD) associated with CKD, 7,8 high-flow arteriovenous fistulas used for dialysis access, 6 anaemia, 4,9 recurrent pulmonary embolisms, 10 fluid overload 11 left ventricular (LV) systolic and diastolic dysfunction.…”

“…The incidence of new onset PH after initiation of maintenance HD is high, and prevalence increases with number of years spent receiving dialysis . Peritoneal dialysis (PD) patients also appear to have a high prevalence of PH …”