Parathyroid hormone, pulmonary artery pressure and right ventricular function in patients undergoing/awaiting...

Cardiovascular disease is a leading cause of death in chronic kidney disease (CKD) patients, with pulmonary hypertension (PH) and right ventricular (RV) dysfunction being especially detrimental. Secondary hyperparathyroidism (SHPT), common in CKD-mineral and bone disorder (CKD-MBD), has been linked to vascular problems, but its specific role in pulmonary vascular disease and RV function in hemodialysis (HD) patients remains unclear.This study examined the relationship between serum intact parathyroid hormone (iPTH), pulmonary artery pressure (PAP), and RV function in CKD patients (both on HD and pre-dialysis). The hypothesis was that higher iPTH correlates with increased PAP and worse RV function.

A total of 115 CKD patients (69.6% HD, 30.4% pre-dialysis) were enrolled. Clinical data included iPTH, calcium, phosphorus, and albumin. Echocardiography measured pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and fractional area change (FAC). Statistical analyses adjusted for confounders.

PH prevalence was 60%. Severe PH patients had significantly higher mean iPTH (P=0.001). In the HD group, elevated iPTH strongly linked to severe PH (p<0.001); each unit iPTH increase raised PH risk by 1.01-fold (P=0.004). However, no direct iPTH-RV function association was found.

Elevated iPTH and longer HD duration are significant PH risk factors in CKD, particularly in HD patients. These findings underscore the need for CKD-MBD management and suggest that PTH-lowering therapies may reduce PH risk and improve cardiovascular outcomes. Further research is needed to identify other contributors to RV dysfunction in CKD.