title: Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD.
abstract: Pulmonary hypertension (PH) is associated with poor outcomes in the dialysis and general populations, but its effect in CKD is unclear. We evaluated the prevalence and predictors of PH measures and their associations with long-term clinical outcomes in patients with nondialysis-dependent CKD. Chronic Renal Insufficiency Cohort (CRIC) Study participants who had Doppler echocardiography performed were considered for inclusion. PH was defined as the presence of estimated pulmonary artery systolic pressure (PASP) >35 mmHg and/or tricuspid regurgitant velocity (TRV) >2.5 m/s. Associations between PH, PASP, and TRV and cardiovascular events, renal events, and all-cause mortality were examined using Cox proportional hazards models. Of 2959 eligible participants, 21% (n=625) had PH, with higher rates among those with lower levels of kidney function. In the multivariate model, older age, anemia, lower left ventricular ejection fraction, and presence of left ventricular hypertrophy were associated with greater odds of having PH. After adjusting for relevant confounding variables, PH was independently associated with higher risk for death (hazard ratio, 1.38; 95% confidence interval, 1.10 to 1.72) and cardiovascular events (hazard ratio, 1.23; 95% confidence interval, 1.00 to 1.52) but not renal events. Similarly, TRV and PASP were associated with death and cardiovascular events but not renal events. In this study of patients with CKD and preserved left ventricular systolic function, we report a high prevalence of PH. PH and higher TRV and PASP (echocardiographic measures of PH) are associated with adverse outcomes in CKD. Future studies may explain the mechanisms that underlie these findings.
authors.affiliation: Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas; sankar.navaneethan@bcm.edu.
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.affiliation: Department of Biostatistics and Epidemiology.
authors.forename: Jason
authors.initials: J
authors.lastname: Roy
authors.affiliation: Department of Biostatistics and Epidemiology.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Tao
authors.affiliation: Division of Nephrology, University of Illinois, Chicago, Illinois;
authors.forename: Carolyn S
authors.initials: CS
authors.lastname: Brecklin
authors.affiliation: Division of Nephrology, Tulane University School of Medicine, New Orleans, Louisiana;
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Division of Cardiovascular Medicine, and.
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.affiliation: Divisions of Nephrology and.
authors.forename: John M
authors.initials: JM
authors.lastname: Flack
authors.affiliation: Division of Nephrology, University of Michigan, Ann Arbor, Michigan;
authors.forename: Akinlolu O
authors.initials: AO
authors.lastname: Ojo
authors.affiliation: Division of Cardiovascular Medicine, and.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Plappert
authors.affiliation: Division of Nephrology, George Washington University, Washington, DC;
authors.forename: Dominic S
authors.initials: DS
authors.lastname: Raj
authors.affiliation: Pulmonary Critical Care and Sleep Medicine, Wayne State University, Detroit, Michigan;
authors.forename: Ghulam
authors.initials: G
authors.lastname: Saydain
authors.affiliation: Divisions of Nephrology and.
authors.forename: James H
authors.initials: JH
authors.lastname: Sondheimer
authors.affiliation: Department of Nephrology, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; and.
authors.forename: Ruchi
authors.initials: R
authors.lastname: Sood
authors.affiliation: Division of Nephrology and Hypertension, St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Steigerwalt
authors.affiliation: Renal, Electrolyte and Hypertension Division at Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.affiliation: Department of Pulmonary and Critical Care Medicine at the Respiratory Institute, Cleveland Clinic, Cleveland, Ohio;
authors.forename: Raed A
authors.initials: RA
authors.lastname: Dweik
authors.affiliation: Department of Nephrology, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; and.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000453:epidemiology; D062186:Arterial Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002423:Cause of Death; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011651:Pulmonary Artery / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors; D013318:Stroke Volume; D014262:Tricuspid Valve Insufficiency / Q000401:mortality; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology; D055815:Young Adult
keywords: CKD; heart failure; mortality; pulmonary hypertension