Haemodialysis patient with chronic kidney disease and pulmonary hypertension treated effectively with pulmonary vasodilators

Abstract

A male patient in his 70s on periodic haemodialysis complained of dysdialysis several months prior and was diagnosed subsequently with pulmonary hypertension (PH). To confirm this diagnosis, a catheter examination was performed after haemodialysis in the dry state. Pulmonary artery wedge pressure (PAWP), mean pulmonary artery (PA) pressure, cardiac index (CI) and pulmonary vascular resistance (PVR) were 9 mm Hg, 42 mm Hg, 2.63 L/min/m2 and 5.9 WU, respectively. The pathophysiological diagnosis was precapillary PH, which mimicked idiopathic PH. The pulmonary vasodilators were administered in a careful sequential manner. After initiation of therapy, dysdialysis disappeared within a few months, while mean PA pressure, CI and PVR improved to 24 mm Hg, 3.47 L/min/m2 and 2.3 WU, respectively. Although the cause of PH in haemodialysis patients is multifactorial, catheter examination in the dry state is useful for clarifying a patient’s haemodynamic state. In a haemodialysis PH patient with precapillary PH, pulmonary vasodilators are an effective treatment option.