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Pulmonary hypertension in patients on chronic hemodialysis and with heart failure
Author(s) -
Hsieh Chinwen,
Lee Chiente,
Chen Chunchuan,
Hsu Liping,
Hu Haohuan,
Wu Jungchou
Publication year - 2016
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12380
Subject(s) - medicine , hazard ratio , hemodialysis , cardiology , heart failure , pulmonary hypertension , kidney disease , odds ratio , proportional hazards model , confidence interval , pulmonary artery
Pulmonary hypertension ( PH ) is linked to chronic kidney disease. However, few studies have examined the prevalence, risk factors, or outcomes of PH in patients with chronic hemodialysis and concomitant heart failure. This retrospective cohort study enrolled 160 patients with a history of acute decompensated heart failure after maintenance hemodialysis therapy. All patients were prospectively observed until D ecember 2013 or death. PH was defined as pulmonary artery systolic pressure >35 mmHg, as determined through echocardiography. Fifty‐one (32%) patients had PH , more of whom were female (70% vs. 52%, P = 0.04). The patients with PH had a lower body mass index (21.8 vs. 23.0, P = 0.03), higher cardiothoracic ratio (55% vs. 52%, P = 0.006), larger left atrium (38.5 vs. 35.7 mm, P = 0.01), and an increased proportion of mitral regurgitation ( MR ) (73% vs. 38%, P < 0.001) compared with the patients who did not have PH . In the multivariate regression analysis, MR was associated most strongly with PH (odds ratio 3.75, 95% confidence interval [ CI ]: 1.67–8.43, P = 0.001). In the multivariate Cox proportional hazard models, PH was related independently to all‐cause mortality (hazard ratio [ HR ], 3.11; 95% CI , 1.53–6.31; P = 0.002) and combined cardiovascular events ( HR , 2.71; 95% CI , 1.66–4.44; P < 0.001) after the model was adjusted for conventional cardiovascular risk factors. PH is related to MR and independently associated with increased all‐cause mortality and cardiovascular events in patients with chronic hemodialysis and heart failure.