title: Presence and outcomes of kidney disease in patients with pulmonary hypertension.
abstract: OBJECTIVE
  Pulmonary hypertension is associated with higher mortality rates. The associations of nondialysis-dependent CKD and all-cause mortality in patients with pulmonary hypertension were studied.
  
  
  METHODS
  The study population included those patients who underwent right heart catheterization for confirmation of pulmonary hypertension between 1996 and January 2011. Pulmonary hypertension was defined as the presence of mean pulmonary artery pressure ≥ 25 mmHg at rest measured by right heart catheterization. CKD was defined as the presence of two measurements of eGFR<60 ml/min per 1.73 m(2) 90 days apart. The risk factors associated with CKD as well as the association between CKD and death in those patients with pulmonary hypertension using logistic regression and Cox proportional hazard models were examined.
  
  
  RESULTS
  Of 1088 patients with pulmonary hypertension, 388 (36%) patients had CKD: 340 patients had stage 3 CKD, and 48 (4%) patients had stage 4 CKD. In the multivariable analysis, older age, higher hemoglobin, and higher mean right atrial pressures were independently associated with CKD. During a median follow-up of 3.2 years (interquartile range=1.5-5.6 years), 559 patients died. After adjusting for relevant covariates, presence of stage 3 CKD (hazard ratio, 1.37; 95% confidence interval, 1.14 to 1.66) and stage 4 CKD (hazard ratio, 2.69; 95% confidence interval, 1.88 to 3.86) was associated with all-cause mortality in those patients with pulmonary hypertension. When eGFR was examined as a continuous measure, a 5 ml/min per 1.73 m(2) lower eGFR was associated with a 5% (95% confidence interval, 1.03 to 1.07) higher hazard for death. This higher risk with CKD was similar irrespective of demographics, left ventricular function, and pulmonary capillary wedge pressure.
  
  
  CONCLUSIONS
  In a clinical population referred for right heart catheterization, presence of CKD was associated with higher all-cause mortality in those patients with pulmonary hypertension. Mechanisms that may underlie these associations warrant additional studies.
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute,, ‡Respiratory Institute,, §Medicine Institute, and, ‖Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, †Cleveland Clinic Lerner College of Medicine and, ¶Department of Nephrology, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.forename: Edgard
authors.initials: E
authors.lastname: Wehbe
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Heresi
authors.forename: Varun
authors.initials: V
authors.lastname: Gaur
authors.forename: Omar A
authors.initials: OA
authors.lastname: Minai
authors.forename: Susana
authors.initials: S
authors.lastname: Arrigain
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Nally
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Schold
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.forename: Raed A
authors.initials: RA
authors.lastname: Dweik
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D016277:Ventricular Function, Left
chemical_list: D006454:Hemoglobins