title: Subcutaneous treprostinil was effective and tolerable in a patient with severe pulmonary hypertension associated with chronic kidney disease on hemodialysis.
abstract: BACKGROUND
  Pulmonary hypertension (PH) is a life-threatening complication in patients with chronic kidney disease on hemodialysis (CKD-HD).
  
  
  OBJECTIVE
  To determine whether subcutaneous infusion of treprostinil was effective and tolerable CKD-PH.
  
  
  RESULTS
  A 57-year-old man was admitted to our hospital due to presyncope and dyspnea during exercise with a history of CKD-HD. Cardiac catheterization revealed high pulmonary arterial pressure (PAP) of 53/24/32 mmHg and pulmonary vascular resistance (PVR) of 11.2 w.u. Upfront combination therapy with bosentan and sildenafil was started. However, 6-month therapy did not attenuate his symptoms, probably due to the high PAP and PVR (60/19/30 mmHg and 5.9 w.u.). We added subcutaneous treprostinil. Surprisingly, 9-month treprostinil (50 ng/kg/min) normalized hemodynamics (PAP: 25/4/13 mmHg and PVR: 1.9 w.u.). His symptoms during excise disappeared without any adverse effects.
  
  
  CONCLUSIONS
  This is the first report that subcutaneous treprostinil was very effective and tolerable in a PH patient with CKD-HD.
authors.affiliation: Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan. Electronic address: koabe@cardiol.med.kyushu-u.ac.jp.
authors.forename: Kohtaro
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Koshin
authors.initials: K
authors.lastname: Horimoto
authors.affiliation: Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Hosokawa
authors.affiliation: Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Kisho
authors.initials: K
authors.lastname: Ohtani
authors.affiliation: Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsui
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance; D011464:Epoprostenol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy; D012720:Severity of Illness Index
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol; C427248:treprostinil
keywords: Chronic kidney disease; Hemodialysis; Infection; Pulmonary hypertension; Treprostinil