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Multicenter Study
. 2016 Mar;27(3):877-86.
doi: 10.1681/ASN.2014111111. Epub 2015 Sep 18.

Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD

Sankar D Navaneethan  1 , Jason Roy  2 , Kelvin Tao  2 , Carolyn S Brecklin  3 , Jing Chen  4 , Rajat Deo  5 , John M Flack  6 , Akinlolu O Ojo  7 , Theodore J Plappert  5 , Dominic S Raj  8 , Ghulam Saydain  9 , James H Sondheimer  6 , Ruchi Sood  10 , Susan P Steigerwalt  11 , Raymond R Townsend  12 , Raed A Dweik  13 , Mahboob Rahman  10 ; Chronic Renal Insufficiency Cohort Investigators
Collaborators, Affiliations
Multicenter Study

Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD

Sankar D Navaneethan et al. J Am Soc Nephrol. 2016 Mar.

Abstract

Pulmonary hypertension (PH) is associated with poor outcomes in the dialysis and general populations, but its effect in CKD is unclear. We evaluated the prevalence and predictors of PH measures and their associations with long-term clinical outcomes in patients with nondialysis-dependent CKD. Chronic Renal Insufficiency Cohort (CRIC) Study participants who had Doppler echocardiography performed were considered for inclusion. PH was defined as the presence of estimated pulmonary artery systolic pressure (PASP) >35 mmHg and/or tricuspid regurgitant velocity (TRV) >2.5 m/s. Associations between PH, PASP, and TRV and cardiovascular events, renal events, and all-cause mortality were examined using Cox proportional hazards models. Of 2959 eligible participants, 21% (n=625) had PH, with higher rates among those with lower levels of kidney function. In the multivariate model, older age, anemia, lower left ventricular ejection fraction, and presence of left ventricular hypertrophy were associated with greater odds of having PH. After adjusting for relevant confounding variables, PH was independently associated with higher risk for death (hazard ratio, 1.38; 95% confidence interval, 1.10 to 1.72) and cardiovascular events (hazard ratio, 1.23; 95% confidence interval, 1.00 to 1.52) but not renal events. Similarly, TRV and PASP were associated with death and cardiovascular events but not renal events. In this study of patients with CKD and preserved left ventricular systolic function, we report a high prevalence of PH. PH and higher TRV and PASP (echocardiographic measures of PH) are associated with adverse outcomes in CKD. Future studies may explain the mechanisms that underlie these findings.

Keywords: CKD; heart failure; mortality; pulmonary hypertension.

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Figures

Figure 1.
Figure 1.
Clinical outcomes in those with and without Pulmonary Hypertension. Kaplan-Meier curve for mortality, cardiovascular (CV) events, and renal events for those with and without PH (defined as PASP>35 mmHg and/or TRV>2.5 m/s).
Figure 2.
Figure 2.
Cardiovascular (CV) event rates. (A) TRV and CV event rates among various stages of CKD. (B) PASP and CV event rates among various stages of CKD.
See this image and copyright information in PMC

Comment in

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