title: Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-study.
abstract: Pulmonary hypertension (PH) is common in patients with dialysis-dependent chronic kidney disease and is an independent predictor of mortality. However, specific hemodynamics of the pulmonary circulation, changes induced by hemodialysis and characterization into pre- or postcapillary PH have not been evaluated in patients with chronic kidney disease. We assessed consecutive patients with end-stage chronic kidney disease in WHO FC ≥ II with dyspnea unexplained by other causes on hemodialysis (group 1, n = 31) or without dialysis (group 2, n = 31) using right heart catheterization (RHC). In group 1, RHC was performed before and after dialysis. In end-stage chronic kidney disease, prevalence of precapillary PH was 13% (4/31), and postcapillary PH was discovered in 65% (20/31). All four cases of precapillary PH were unmasked after dialysis. In group 2, two cases of precapillary PH were detected (6%), and postcapillary PH was diagnosed in 22 cases (71%). This is the first study examining a large cohort of patients with chronic kidney disease invasively by RHC for the prevalence of PH. The prevalence of precapillary PH was 13% in patients with end-stage kidney disease. That suggests careful screening for precapillary PH in this selected patient population. RHC should be performed after hemodialysis.
authors.affiliation: The Department of Internal Medicine II - Cardiology/Pneumology, University of Bonn, Bonn, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Pabst
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Felix
authors.initials: F
authors.lastname: Hundt
authors.forename: Thomas
authors.initials: T
authors.lastname: Gerhardt
authors.forename: Christian
authors.initials: C
authors.lastname: Grohé
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Rainer
authors.initials: R
authors.lastname: Woitas
authors.forename: Dirk
authors.initials: D
authors.lastname: Skowasch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis