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Pulmonary Hypertension Subtypes and Mortality in CKD
Daniel L Edmonston1, Kishan S Parikh2, Sudarshan Rajagopal3
1Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Summary
Pulmonary hypertension (PH) is common in chronic kidney disease (CKD) and linked to worse survival. Combined pre- and postcapillary PH poses the highest mortality risk for CKD patients.
Area of Science:
- Cardiology
- Nephrology
- Pulmonary Medicine
Background:
- Pulmonary hypertension (PH) significantly contributes to cardiovascular disease and mortality in patients with chronic kidney disease (CKD).
- The underlying pathophysiology linking PH and CKD remains largely unknown.
- Understanding PH prevalence and its subtypes in CKD is crucial for patient outcomes.
Purpose of the Study:
- To estimate the prevalence of pulmonary hypertension (PH) subtypes in patients with chronic kidney disease (CKD).
- To investigate the consequences and mortality risks associated with different PH subtypes in the context of CKD.
Main Methods:
- An observational retrospective cohort study was conducted.
- 12,618 patients who underwent right heart catheterization between 2000 and 2014 were analyzed.
- Multivariable Cox proportional hazards analysis was used to assess mortality risk.
Main Results:
- PH was more prevalent in CKD patients (73.4%) compared to non-CKD patients (56.9%).
- Combined pre- and postcapillary PH was the most common subtype in CKD and associated with the highest mortality risk.
- Precapillary PH conferred the highest mortality risk in non-CKD patients.
Conclusions:
- Pulmonary hypertension is highly prevalent in CKD patients referred for right heart catheterization and is associated with increased mortality.
- Combined pre- and postcapillary PH is a common subtype in CKD and carries the worst survival prognosis.
- Further research into the mechanisms and management of PH in CKD is warranted.
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