Prognostic value of pulmonary hypertension in pre-dialysis chronic kidney disease patients
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NEPHROLOGY - ORIGINAL PAPER
Prognostic value of pulmonary hypertension in pre‑dialysis chronic kidney disease patients Xiaohao Zhang1 · Wenbo Zhao1 · Xinxin Ma1 · Yuanqing Li1 · Hongli Shang1 · Jun Zhang1 · Zengchun Ye1 · Xun Liu1 · Tanqi Lou1 · Yu Peng2 · Hui Peng1 Received: 25 March 2020 / Accepted: 27 July 2020 © Springer Nature B.V. 2020
Abstract Background Pulmonary hypertension is common in chronic kidney disease (CKD) patients. However, the prognostic value of pulmonary hypertension in Chinese predialytic CKD patients is rarely reported. We evaluated the relevant factors and prognostic value of pulmonary hypertension in CKD patients. Methods This retrospective cohort study enrolled 1092 predialytic patients from The Third Affiliated Hospital of Sun YatSen University from May 1st, 2011, to December 31st, 2016. Data of interest were retrieved from electronic medical records. Pulmonary hypertension was defined as pulmonary arterial systolic pressure (PASP) ≥ 35 mmHg by echocardiology. All participants were followed from the date of the first echocardiography examination. The primary endpoints were all-cause mortality and cardiovascular mortality. The secondary endpoint was end-stage renal disease (ESRD) defined as starting renal replacement therapy. Results The prevalence of pulmonary hypertension was 15.9% in the study population. For CKD stage 1, 2, 3a, 3b, 4 and 5, the prevalence was 6.0%, 9.6%, 17.2%, 13.3%, 20.7% and 26.6%, respectively. Older age, lower left ventricular ejection fraction, anemia and higher pulse pressure were independently associated with pulmonary hypertension in CKD patients. In multivariate Cox regression analysis, pulmonary hypertension was the independent risk factor for cardiovascular mortality, but not of all-cause mortality and ESRD. Conclusions Pulmonary hypertension is not rare in early CKD patients. Patients with older age, anemia, higher pulse pressure and compromised heart function were more likely to comorbid pulmonary hypertension. Pulmonary hypertension maybe a sign of worse cardiovascular outcome in CKD patients. Keywords Pulmonary hypertension · Chronic kidney disease · Prognosis
Introduction Xiaohao Zhang and Wenbo Zhao contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11255-020-02589-6) contains supplementary material, which is available to authorized users. * Yu Peng [email protected] * Hui Peng [email protected] 1
Nephrology Division, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Avenue, Guangzhou 510630, China
Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Guangzhou 510120, China
2
Chronic kidney disease (CKD) is a global disease. In the United States of America, the prevalence of CKD is 14.8% and the incidence of end-stage renal disease (ESRD) is 370 per million person-years [1]. In China, the prevalence of CKD is 10.8
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