Incident Pulmonary Hypertension and Its Risk Factors in CKD

Lower eGFR and higher B-type natriuretic peptide are associated with increased odds of developing pulmonary hypertension. Albuminuria was not associated with the development of incident pulmonary hypertension.

Pulmonary hypertension (PH) is a common comorbid condition in patients with CKD and is associated with high mortality. We sought to identify the incidence of PH and the relation of kidney function and volume status to its development in a large cohort of patients with CKD.

The study sample included 1076 participants from the Chronic Renal Insufficiency Cohort Study with two or more measurements of tricuspid regurgitation velocity by transthoracic echocardiography. Incident PH was defined as a tricuspid regurgitation velocity of ≥2.8 m/s (reflecting a right ventricular systolic pressure gradient ≥31 mm Hg). Multivariable logistic regression adjusting for demographics, comorbid conditions, and medications was used to evaluate the relation of kidney function (eGFR and albuminuria) as well as B-type natriuretic peptide (BNP) to incident PH.

Over a median of 3.0 years, 120 patients developed incident PH (incidence rate 2.70 cases per 100 person-years). Each 10 ml/min per 1.73 m 2 lower eGFR was associated with 29% (odds ratio, 1.29; 95% confidence interval, 1.10 to 1.52) higher odds of the development of PH after adjustment for confounders, while each doubling of BNP was associated with a 32% (odds ratio, 1.32; 95% confidence interval, 1.15 to 1.51) higher odds. There was no significant relation between urine albumin excretion and incident PH.

eGFR and BNP were independently associated with the development of incident PH. Closer attention to these potentially modifiable risk factors is warranted to slow the progression of this common comorbidity of patients with CKD.