Pulmonary Hypertension and Kidney Disease: A Review of a High-Risk Patient Population

Pulmonary hypertension (PH) is a multifaceted disease driven by increased pulmonary vascular resistance and right ventricular afterload, eventually progressing to right-sided heart failure and a high mortality rate. Kidney dysfunction, a common comorbidity in patients with PH, complicates treatment and impacts prognosis. In this literature review, we seek to broadly explore this coincidence of diseases, primarily focusing on chronic kidney disease (CKD) developing after a primary diagnosis of pulmonary arterial hypertension (PAH). We discuss prevalence, pathophysiologic mechanisms of disease, management of disease including the use of primary PAH therapies in the setting of renal disease, as well as background therapy for kidney disease and PAH comorbidities. This paper further seeks to evaluate associated comorbid conditions such as anemia and iron deficiency. We performed a literature search of several online medical databases, with a primary focus on Pubmed, to explore the findings of multiple systematic reviews and meta-analyses, clinical trials, and preclinical studies using animal models, among others. We found that while there is generally a good amount of consensus data for PH, CKD, and PH in the setting of preexisting CKD, little has been published regarding the specific focus of patients developing kidney dysfunction in the setting of PH.