Pulmonary hypertension in hemodialysis patients: frequency and risk factors

Abstract

Objective The authors aimed to determine the prevalence of pulmonary hypertension in patients with end-stage kidney disease on regular hemodialysis (HD). The authors also aimed to study the possible correlation between the occurrence of pulmonary hypertension and fluid overload, arteriovenous fistula (AVF) blood flow, valvular calcification, and other laboratory variables. Patients and methods This cross-sectional descriptive study was conducted on 80 patients with end-stage kidney disease on regular HD for more than one year in Al Agoza Hospital in Cairo, Egypt. General data were collected. A transthoracic 2D echocardiography was done for all studied patients within one hour after HD. Pulmonary hypertension's definition was an estimation of pulmonary artery systolic pressure greater than 35 mmHg by echocardiography. Results Pulmonary hypertension (pulmonary artery systolic pressure >35 mmHg) presented in 21 (26.2%) patients, whereas mild (35–50 mmHg), moderate (51–70 mmHg), and severe pulmonary hypertension (>70 mmHg) presented in seven (8.8%), 10 (12.5%), and four (5%) patients, respectively. Pulmonary hypertension presented in 13 (62%) female patients vs eight (38%) male patients, which is of statistical significance (P<0.001). Mean duration of dialysis was significantly higher in patients with pulmonary hypertension (PHTN) than those without (8.54±3.53 years vs 3.88±1.01 years; P<0.001). Valvular calcification, fluid overload, and blood flow through AVF were significantly correlated to the development of PHTN. Conclusion Pulmonary hypertension in patients with end stage kidney disease (ESKD) on regular HD is frequent. Blood flow through AVF and chronic fluid overload may be involved in the development of PHTN in patients with ESKD who are on regular hemodialysis.