title: Estimated pulmonary artery systolic pressure and self-reported physical function in patients on hemodialysis.
abstract: OBJECTIVE
  Patients on chronic hemodialysis have a high prevalence of heart disease and poor self-reported physical function. The association between structural heart disease and self-reported physical function in patients on hemodialysis is unknown.
  
  
  METHODS
  We studied the association between elevated pulmonary artery systolic pressure (PASP) and self-reported physical function in ESRD in 253 patients in the USRDS ACTIVE/ADIPOSE study between 2009 and 2011. We used multivariate linear regression with PASP obtained from clinical echocardiogram reports as the primary predictor and the Physical Function (PF) subscale of the SF-36 as the primary outcome. To determine whether associations between PASP and PF were driven by fluid overload or left ventricular hypertrophy, we assessed whether PASP was associated with bioimpedance spectroscopy (BIS)-derived extracellular water (ECW) and with left ventricular posterior wall thickness.
  
  
  RESULTS
  In a multivariable model, each 10 mm Hg higher PASP was associated with a 3.32-point lower PF score (95% CI -5.95, -0.68). In a multivariable model that included BIS estimates, both left ventricular posterior wall thickness (LVPW, per 5 mm) and ECW were associated with a higher PASP (LVPW 4.21 mm Hg, 95% 0.38-8.04; ECW 1.12 mm Hg per liter, 95% CI 0.07-2.18). Higher LVPW and ECW were independently associated with a lower PF score.
  
  
  CONCLUSIONS
  Left ventricular hypertrophy and elevated pulmonary pressure are associated with worse self-reported physical function in patients on hemodialysis. The role of chronic volume overload on PASP and PF score should be evaluated in a prospective manner.
authors.affiliation: Division of Nephrology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Abreo
authors.forename: Charles A
authors.initials: CA
authors.lastname: Herzog
authors.forename: Nancy G
authors.initials: NG
authors.lastname: Kutner
authors.forename: Janice
authors.initials: J
authors.lastname: Lea
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Johansen
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015331:Cohort Studies; D058266:Dielectric Spectroscopy; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006435:Renal Dialysis; D057566:Self Report; D011795:Surveys and Questionnaires; D013599:Systole