Pulmonary hypertension in ckd: A new problem child

Abstract

Pulmonary hypertension (PH) is prevalent in chronic kidney disease (CKD) patients, particularly in those on chronic hemodialysis treatment. Concomitant diseases and several CKD-specific risk factors, including the presence of artero-venous fistula, fluid overload, sleep breathing disorders and the exposure to dialysis membranes, can be implicated at various level in the genesis of PH in the CKD population. PH in CKD is a potentially reversible process because it may regress after kidney transplantation. In small cohort studies on stage 5 CKD pre-dialysis and dialysis patients, PH was associated with a higher risk of death. Large prospective studies adopting well standardized criteria of pulmonary artery pressure measurement, such as right heart catheterization, are needed to clarify the risk of PH in earlier CKD stages. Clinical trials are eagerly awaited to define the optimal therapeutic management of CKD patients with PH.