title: Association of Pulmonary Hypertension with Mortality in Incident Peritoneal Dialysis Patients.
abstract: BACKGROUND
  The prognostic value of pulmonary hypertension at the start of peritoneal dialysis (PD) in patient survival is unclear.
  
  
  METHODS
  We conducted a retrospective study of incident patients who initiated PD therapy from January 2007 to December 2011, and followed up through June 2013. Pulmonary hypertension was defined as an estimated systolic pulmonary artery pressure (PAP) of ≥ 35 mm Hg using echocardiography. Clinical parameters and laboratory findings were compared between patients with and without pulmonary hypertension and a logistic regression model was elaborated. Patient outcomes (all-cause and cardiovascular mortality) were recorded during follow-up. Survival curves were constructed by the Kaplan-Meier method, and the influences of pulmonary hypertension on outcomes were analyzed by Cox regression models.
  
  
  RESULTS
  Pulmonary hypertension was prevalent in 99 (16.0%) of the 618 patients studied. The independent risk factors for pulmonary hypertension were female (odds ratio [OR] = 2.12; 95% confidence interval [CI]: 1.29 - 3.46), left atrial diameter (OR = 1.15; 95% CI: 1.10 - 1.20), left ventricular ejection fraction (OR = 0.97; 95% CI: 0.95 - 0.99), and serum sodium (OR = 0.94; 95% CI: 0.89 - 0.99). Over a median follow-up of 29.4 months, 93 patients (15.0%) died, 59.1% of them due to cardiovascular disease. Kaplan-Meier survival analysis showed that patients with pulmonary hypertension had worse overall rates of survival and cardiovascular death-free survival than those without pulmonary hypertension. After multivariate adjustment, pulmonary hypertension was independently associated with increased risk for both all-cause and cardiovascular mortality, with hazard ratios (HRs) of 2.10 (95% CI: 1.35 - 3.27) and 2.60 (95% CI: 1.48 - 4.56), respectively.
  
  
  CONCLUSIONS
  The prevalence of pulmonary hypertension at the start of PD was common and associated with increased risk of both all-cause and cardiovascular mortality in incident PD patients.
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
authors.forename: Qingdong
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Xiong
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
authors.forename: Li
authors.initials: L
authors.lastname: Fan
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
authors.forename: Fenghua
authors.initials: F
authors.lastname: Xu
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
authors.forename: Huiyan
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Peng
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
authors.forename: Shirong
authors.initials: S
authors.lastname: Cao
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
authors.forename: Xueqing
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China haipingmao@126.com.
authors.forename: Haiping
authors.initials: H
authors.lastname: Mao
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: End-stage renal disease; peritoneal dialysis; pulmonary hypertension; survival