Relationship between pulmonary hypertension, peripheral vascular calcification, and major cardiovascular events in dialysis patients.
BACKGROUND
Pulmonary hypertension (PHT) is a recently recognized complication of chronic kidney disease. In this study, we investigated the association between PHT, peripheral vascular calcifications (VCs), and major cardiovascular events.


METHODS
In this retrospective study, we included 172 end-stage renal disease (ESRD) patients undergoing dialysis [hemodialysis (HD)=84, peritoneal dialysis=88]. PHT was defined as an estimated pulmonary artery systolic pressure>37 mmHg using echocardiography. The Simple Vascular Calcification Score (SVCS) was measured using plain radiographic films of the hands and pelvis.


RESULTS
The prevalence of PHT was significantly higher in HD patients (51.2% vs. 22.7%). Dialysis patients with PHT had a significantly higher prevalence of severe VCs (SVCS≥3). In multivariate analysis, the presence of severe VCs [odds ratio (OR), 2.68], mitral valve disease (OR, 7.79), HD (OR, 3.35), and larger left atrial diameter (OR, 11.39) were independent risk factors for PHT. In addition to the presence of anemia, severe VCs, or older age, the presence of PHT was an independent predictor of major cardiovascular events in ESRD patients.


CONCLUSIONS
The prevalence of PHT was higher in HD patients and was associated with higher rates of major cardiovascular events. Severe VCs are thought to be an independent risk factor for predicting PHT in ESRD patients. Therefore, in dialysis patients with PHT, careful attention should be paid to the presence of VCs and the occurrence of major cardiovascular events.
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Sun Chul
SC
Kim
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Hyo Jung
HJ
Chang
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Myung-Gyu
MG
Kim
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Sang-Kyung
SK
Jo
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Won-Yong
WY
Cho
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
Hyoung-Kyu
HK
Kim
Cardiovascular disease; Dialysis; Pulmonary hypertension