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Inicio Medicina Clínica (English Edition) Pulmonary hypertension in hemodialysis patients: Prevalence and associated facto...
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Vol. 146. Issue 4.
Pages 143-147 (February 2016)
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Vol. 146. Issue 4.
Pages 143-147 (February 2016)
Original article
Pulmonary hypertension in hemodialysis patients: Prevalence and associated factors
Hipertensión pulmonar en pacientes en hemodiálisis: prevalencia y factores asociados
Javier Requea,
Corresponding author
je.reque.s@gmail.com

Corresponding author.
, Borja Quirogaa, Caridad Ruizb, Maria Teresa Villaverdeb, Almudena Vegaa, Soraya Abada, Nayara Panizoa, J. Manuel López-Gómeza
a Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Clínica de hemodiálisis DIALCENTRO, Madrid, Spain
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Figures (2)
Tables (3)
Table 1. Baseline characteristics.
Table 2. Factors associated with pulmonary hypertension. Univariate logistic regression.
Table 3. Factors independently associated with PH. Multivariate logistic regression (adjusted for age, diabetes, hypertension, dyslipidemia and systolic and diastolic dysfunction).
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Abstract
Background and objective

Pulmonary hypertension (PH) is a progressive disorder that can be caused by several underlying conditions or an intrinsic alteration of the pulmonary vasculature. Chronic increased pressure in the pulmonary vasculature leads to changes in the architecture of the vessels that can perpetuate PH and produce right ventricular dysfunction. These structural and functional alterations can decrease survival and quality of life of patients on hemodialysis; however, there is a lack of evidence about this problem in this population. The aim of this study is to establish the prevalence of PH in patients on hemodialysis and its association with specific factors related to this patient population.

Material and methods

We included 202 prevalent patients on hemodialysis for at least 6 months and who were clinically stable. We collected demographic data, routine laboratory parameters and data of 2D Doppler-echocardiography. PH was defined as a systolic pulmonary artery pressure (SPAP) estimated by Doppler ultrasound above 35mmHg. Hydration status was assessed by determining the plasma concentration of N-terminal pro brain natriuretic peptide (Nt-proBNP).

Results

PH prevalence was 37.1% (75 patients). The average SPAP in the entire study population was 32±12mmHg and in the group with PH it was 45±11mmHg. We found a direct and statistically significant correlation between the presence of PH and age (p=0.001), time on renal replacement therapy (p=0.04), the presence of systolic dysfunction (p=0.007), diastolic dysfunction (p=0.01), mitral valve disease (p=0.01) and double mitral and aortic disease (p=0.007). Volume overload was closely associated with PH, as demonstrated by the correlation between the SPAP and Nt-proBNP levels (p=0.001).

Conclusion

We conclude that prevalence of PH in hemodialysis patients is high. And one of the most important associated factors is volume overload. More studies are needed to establish the impact of PH on morbidity and mortality of patients and to assess whether a better volume control improves PH.

Keywords:
Pulmonary hypertension
Hemodialysis
Cardiovascular risk
Epidemiology
Resumen
Introducción y objetivo

La hipertensión pulmonar (HTP) es un trastorno progresivo que puede deberse a enfermedades subyacentes o a una alteración intrínseca de la vascularización pulmonar. El aumento crónico de la presión en el árbol vascular pulmonar lleva a cambios en la arquitectura de los vasos que perpetúan la propia HTP y producen disfunción ventricular derecha; todo esto podría disminuir la supervivencia y calidad de vida de los pacientes. El objetivo de este estudio es establecer la prevalencia de HTP en los pacientes en hemodiálisis y su asociación con factores propios de este grupo de pacientes.

Material y métodos

Incluimos a un total de 202 pacientes prevalentes en hemodiálisis durante al menos 6 meses y estables clínicamente, se recogieron datos demográficos, parámetros analíticos de rutina y los datos de un ecocardiograma doppler-2D. Definimos HTP como una presión sistólica de arteria pulmonar (PSAP) estimada mediante ecografía doppler por encima de 35mmHg. El estado de hidratación se valoró mediante la determinación de los niveles de fragmento N terminal del péptido natriurético cerebral (Nt-proBNP).

Resultados

La prevalencia de HTP fue del 37,1% (75 pacientes). La media de PSAP en toda la población estudiada fue de 32±12mmHg y en el grupo con HTP de 45±11mmHg. Encontramos una correlación directa estadísticamente significativa entre la presencia de HTP y la edad (p=0,001), el tiempo en tratamiento renal sustitutivo (p=0,04), la presencia de disfunción sistólica (p=0,007), disfunción diastólica (p=0,01), valvulopatía mitral (p=0,01) y doble lesión mitral y aórtica (p=0,007). La sobrecarga de volumen se asocia estrechamente con HTP como se demuestra por la correlación entre la PSAP y los niveles de Nt-ProBNP (p=0,001).

Conclusión

Concluimos que la prevalencia de HTP en los pacientes en hemodiálisis es alta y uno de los factores asociados más importante es la hipervolemia. Son necesarios más estudios para establecer el impacto de la HTP sobre la morbimortalidad de los pacientes y valorar si un mejor control de la volemia lleva a mejoría de la HTP.

Palabras clave:
Hipertensión pulmonar
Hemodiálisis
Riesgo cardiovascular
Epidemiología

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