Prevalence and Predictors of Pulmonary Hypertension in End-Stage Renal Disease: a Single-Center Cross-Sectional Study

Pulmonary hypertension (PH) is highly prevalent in patients with chronic kidney disease (CKD) and is a strong predictor of mortality. The relative contributions of vascular access for hemodialysis (HD) in the pathogenesis of PH remain under debate. This study analyses the prevalence and potential predictors of PH in End-stage renal disease (ESRD).

A retrospective cross-sectional study of 51 CKD patients on maintenance dialysis (86% HD, 14% peritoneal dialysis (PD)) was conducted. Patients underwent comprehensive echocardiography to estimate systolic pulmonary artery pressure (SPAP). Pulmonary hypertension was defined as SPAP > 35 mm Hg. The associations between SPAP and vascular access type, arteriovenous fistula (AVF) location and echocardiographic parameters were analyzed using univariate and multivariable linear regression models.

The prevalence of PH was 31% and the median SPAP was 30 mm Hg. There was no significant difference in SPAP between patients with central venous catheters, proximal AVFs or distal AVFs. Left atrial volume was the strongest independent predictor of SPAP (beta = 0.41, p < 0.001). Elevated E/e' ratio (p = 0.002) and reduced left ventricular ejection fraction (p = 0.016) were significantly associated with SPAP in univariate analysis. PD patients exhibited significantly smaller left atrial volumes compared to HD patients (p = 0.023).

Pulmonary hypertension is frequent in ESRD. The main drivers of PH in ESRD are volume overload and left heart disease. These findings support volume management as the primary therapeutic target for PH in the dialysis population.