title: Pulmonary Hypertension Is Associated with Mortality and Cardiovascular Events in Chronic Kidney Disease Patients.
abstract: BACKGROUND
  We evaluated the prevalence, determinants and prognosis value of pulmonary hypertension (PH) in non-dialysis chronic kidney disease (CKD) patients.
  
  
  METHODS
  This is a prospective study with stages 3-5 non-dialysis-dependent CKD patients. PH was estimated by Doppler echocardiography and defined as a pulmonary artery systolic pressure above 35 mm Hg.
  
  
  RESULTS
  Three hundred fifty-three patients were recruited, of whom 94 (26.6%) had PH. Prevalence of PH increased with the decline of renal function: 21.6, 24.1, and 31.7% in stages 3, 4, and 5, respectively. Independent predictors of PH were age, estimated glomerular filtration rate (eGFR), history of cardiovascular (CV) events, the presence of an arteriovenous fistulae (AVF), and left ventricular (systolic and diastolic) dysfunction. Over a median follow-up of 22 months, 71 patients died (20%). After multivariate adjustment for age, gender, previous CV disease, diastolic and systolic dysfunction, PH remained as an independent predictor of all-cause mortality (hazards ratio [HR] 1.84, 95% CI 1.06-3.18, p = 0.02). One hundred patients (28%) had a new onset CV event. After adjustment for age, gender, previous CV disease, systolic and diastolic dysfunction, PH maintains its independent association with CV events (HR 2.77, 95% CI 2.00-3.25, p < 0.001).
  
  
  CONCLUSIONS
  PH prevalence rises as kidney function declines. Main determinants of PH are age, eGFR, previous CV disease, the presence of an AVF and left ventricular systolic or diastolic dysfunction. PH is an independent predictor of all-cause mortality and CV events.
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Reque
authors.forename: Ana
authors.initials: A
authors.lastname: Garcia-Prieto
authors.forename: Tania
authors.initials: T
authors.lastname: Linares
authors.forename: Almudena
authors.initials: A
authors.lastname: Vega
authors.forename: Soraya
authors.initials: S
authors.lastname: Abad
authors.forename: Nayara
authors.initials: N
authors.lastname: Panizo
authors.forename: Borja
authors.initials: B
authors.lastname: Quiroga
authors.forename: Eladio J
authors.initials: EJ
authors.lastname: Collado Boira
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: López-Gómez
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D001794:Blood Pressure; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*