title: Pulmonary hypertension in patients on chronic hemodialysis and with heart failure.
abstract: Pulmonary hypertension (PH) is linked to chronic kidney disease. However, few studies have examined the prevalence, risk factors, or outcomes of PH in patients with chronic hemodialysis and concomitant heart failure. This retrospective cohort study enrolled 160 patients with a history of acute decompensated heart failure after maintenance hemodialysis therapy. All patients were prospectively observed until December 2013 or death. PH was defined as pulmonary artery systolic pressure >35 mmHg, as determined through echocardiography. Fifty-one (32%) patients had PH, more of whom were female (70% vs. 52%, P = 0.04). The patients with PH had a lower body mass index (21.8 vs. 23.0, P = 0.03), higher cardiothoracic ratio (55% vs. 52%, P = 0.006), larger left atrium (38.5 vs. 35.7 mm, P = 0.01), and an increased proportion of mitral regurgitation (MR) (73% vs. 38%, P < 0.001) compared with the patients who did not have PH. In the multivariate regression analysis, MR was associated most strongly with PH (odds ratio 3.75, 95% confidence interval [CI]: 1.67-8.43, P = 0.001). In the multivariate Cox proportional hazard models, PH was related independently to all-cause mortality (hazard ratio [HR], 3.11; 95% CI, 1.53-6.31; P = 0.002) and combined cardiovascular events (HR, 2.71; 95% CI, 1.66-4.44; P < 0.001) after the model was adjusted for conventional cardiovascular risk factors. PH is related to MR and independently associated with increased all-cause mortality and cardiovascular events in patients with chronic hemodialysis and heart failure.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Pingtung Christian Hospital, Pingtung, Taiwan.
authors.forename: Chin-Wen
authors.initials: CW
authors.lastname: Hsieh
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan.|Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chien-Te
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Pingtung Christian Hospital, Pingtung, Taiwan.
authors.forename: Chun-Chuan
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Pingtung Christian Hospital, Pingtung, Taiwan.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Hsu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Pingtung Christian Hospital, Pingtung, Taiwan.
authors.forename: Hao-Huan
authors.initials: HH
authors.lastname: Hu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Pingtung Christian Hospital, Pingtung, Taiwan.
authors.forename: Jung-Chou
authors.initials: JC
authors.lastname: Wu
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Heart failure; hemodialysis; mitral regurgitation (MR); pulmonary hypertension (PH)