Rajesh Deshpande1, Amit Kumar Yadav2, Vipin Porwal3
BACKGROUND
Multiple mechanisms have been identified contributing to pulmonary arterial
hypertension (PAH) in chronic kidney disease (CKD) patients and it is one of the
important sequelae of CKD and needs early detection. We wanted to study PAH in
various stages of CKD and its association with renal and cardiovascular
parameters.
METHODS
This was an observational study. PAH was diagnosed if mean pulmonary artery
pressure (MPAP) was ≥ 25 mmHg using 2D - Doppler echocardiography in 96 CKD
patients. Staging of CKD was done as per Kidney Disease Improving Global
Outcomes (KDIGO) stages 1 - 5. Age, gender, diabetes, hypertension, stages of
CKD, corticomedullary differentiation (CMD), estimated glomerular filtration rate
(EGFR), urinary albumin creatinine ratio (UACR), left ventricular ejection fraction
(LVEF) and left ventricular hypertrophy (LVH) were included as risk factors. Data
was analysed by calculating percentage, mean, standard deviation, chi square and
t test. P value < 0.05 was taken as statistically significant.
RESULTS
PAH was detected in 37 (38.5 %) of CKD patients. Prevalence of PAH increased
with stages of CKD being highest (59 %) in stage 5 and this was found to be
statistically significant (P = 0.04). PAH was detected earliest in stage 2 (23.5 %).
Lower mean eGFR ml / min / 1.733m2 (24.43 ± 17.8 vs 40.98 ± 25.7, P = 0.001)
altered corticomedullary differentiation (50.9 % vs 20.5 % p = 0.003), reduced
LVEF (81 % vs 26.7 % P = 0.000) and LVH (65 % vs 19.6 %, P = 0.000)
were significantly associated with PAH in CKD patients.
CONCLUSIONS
PAH in CKD patients increases with CKD stages. Onset of PAH in CKD patients may
be earlier and significantly associated with left ventricular dysfunction.
