Prevalence, predictors, and outcomes of pulmonary hypertension in CKD

Abstract

Pulmonary hypertension (PH) is associated with poor outcomes in the dialysis and general populations, but its effect in CKDis unclear.We evaluated the prevalence and predictors of PH measures and their associationswith long-term clinical outcomes in patients with nondialysis-dependent CKD. Chronic Renal Insufficiency Cohort (CRIC) Study participantswho hadDoppler echocardiography performedwere 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 hypertrophywere 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 (echocardiographicmeasures of PH) are associated with adverse outcomes inCKD. Future studies may explain the mechanisms that underlie these findings.