title: High estimated pulmonary artery systolic pressure predicts adverse cardiovascular outcomes in stage 2-4 chronic kidney disease.
abstract: High estimated pulmonary artery systolic pressure (ePASP) is an established risk factor for mortality and cardiovascular (CV) events in the general population. High ePASP predicts mortality in dialysis patients but such a relationship has not been tested in patients with early CKD. Here we estimated the prevalence and the risk factors of high ePASP in 468 patients with CKD stage 2-4 and determined its prognostic power for a combined end point including cardiovascular death, acute heart failure, coronary artery disease, and cerebrovascular and peripheral artery events. High ePASP (35 mm Hg and above) was present in 108 CKD patients. In a multivariate logistic regression model adjusted for age, diabetes, hemoglobin, left atrial volume (LAV/BSA), left ventricular mass (LVM/BSA), and history of CV disease, age (OR, 1.06; 95% CI, 12 1.04-1.09) and LAV/BSA (OR, 1.05; 95% CI, 1.03-1.07) were the sole significant independent predictors of high ePASP. Elevated ePASP predicted a significantly high risk for the combined cardiovascular end point both in unadjusted analyses (HR, 2.70; 95% CI, 1.68-4.32) and in analyses adjusting for age, eGFR, hemoglobin, LAV/BSA, LVM/BSA, and the presence of diabetes and CV disease (HR, 1.75; 95% CI, 1.05-2.91). High ePASP is relatively common in patients with stage 2-4 CKD and predicts adverse CV outcomes independent of established classical and CKD-specific risk factors. Whether high ePASP is a modifiable risk factor in patients with CKD remains to be determined in randomized clinical trials.
authors.affiliation: Clinical Epidemiology of Renal Diseases and Hypertension Unit, CNR-Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Bolignano
authors.affiliation: Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Lennartz
authors.affiliation: Clinical Epidemiology of Renal Diseases and Hypertension Unit, CNR-Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Leonardis
authors.affiliation: Clinical Epidemiology of Renal Diseases and Hypertension Unit, CNR-Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: D'Arrigo
authors.affiliation: Clinical Epidemiology of Renal Diseases and Hypertension Unit, CNR-Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Tripepi
authors.affiliation: Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.
authors.forename: Insa E
authors.initials: IE
authors.lastname: Emrich
authors.affiliation: Clinical Epidemiology of Renal Diseases and Hypertension Unit, CNR-Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mallamaci
authors.affiliation: Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.
authors.forename: Danilo
authors.initials: D
authors.lastname: Fliser
authors.affiliation: Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Heine
authors.affiliation: Clinical Epidemiology of Renal Diseases and Hypertension Unit, CNR-Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005919:Glomerular Filtration Rate; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology*; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000503:physiopathology*; D013599:Systole