Pulmonary hypertension associates with malnutrition and body composition hemodialysis patients

The prevalence of pulmonary hypertension (PH) is reported between 17 and 56% in hemodialysis (HD) patients. Pathogenesis of PH in HD patients is still unclear. Malnutrition associating impaired pulmonary function tests in HD patients previously reported. Present study aimed to investigate an association between PH and nutrition and inflammation HD patients.

Total 179 HD patients (109 M, 70 F) were included. Pulmonary artery pressure (PAP) and ejection fraction (EF) percentage was determined by echocardiography after a midweek HD session. Bioimpedance analyses were performed after dialysis. Percent body fat mass truncal fat (%), total body water (%), body-mass index was determined. Serum 25-OH vitamin D, albumin, lipid parameters, C-reactive protein (CRP), calcium, phosphorus, parathyroid hormone, ferritin levels, and hemogram were studied.

Pulmonary hypertension (PAP>35 mmHg) was found in 48 (26.8%) of 179 patients studied. Body-mass index (BMI) was negatively correlated with PAP (r=-0.34; p=0.02). HD vintage, prevalence of diabetes, sex, type of vascular access were not different between patients with PH and without PH. Patients with PH were older (68.1±14.4; 61.3±14.7; p=0.005). Percent body fat (19.8±8.1% vs. 28.1±10%; p=0.001), albumin (3.4±0.5 g/dl vs. 3.9±3.3 g/dl; p=0.0001), truncal fat (16.8±10.7 vs. 26.4±10.5; p=0.001), triglyceride (147.9±88.5 vs. 182.1±97.7 mg/dl; p=0.03), and total cholesterol (146.9±34.5 vs. 169.5±43 mg/dl; p=0.004) levels were significantly lower in patients with PH than with no PH. Logistic regression analysis revealed that increased percent body fat, albumin, and total cholesterol associate with a decreased risk of PH.

Present study demonstrated a significant association between malnutrition and PH in HD patients. Those results should be confirmed by further prospective studies including cytokine levels and spirometric measurements.