151 Prognostic significance of moderate renal dysfunction in patients with pulmonary arterial hypertension

Abstract

In pulmonary arterial hypertension (PAH), the raise of vascular resistance lead to right ventricular dysfunction, fluid retention and death. In this setting, we evaluated the determinants of moderate renal dysfunction and its impact on mortality. 38 consecutive PAH patients were prospectively enrolled. Right ventricular dysfunction was assessed by echocardiography using two-dimensional strain, tissue Doppler imaging and tricuspid annular displacement (TAPSE). Right-sided catheterism, 6-minute walking distance and biological sampling was performed within 48 hours. Moderate Renal dysfunction was defined by a creatinine clearance below 60 ml/min. In the overall cohort, renal dysfunction was associated with decreased cardiac output, SVO 2, TAPSE, haemoglobin levels, 6 min walking distance and increased BNP levels. By univariate analysis, predictors of mortality were TAPSE < 15 mm (OR: 10.25 95% CI [1.06–29.44]; p = 0.028), BMI < 25 kg/m 2 (OR: 5.00 95% CI [1.04–23.84]; p = 0.043) and renal dysfunction (OR: 9.43 95% CI [1.96–45.29]; p = 0.005). By multivariate analysis, renal dysfunction remains the sole independent predictor of mortality at one year follow-up (OR: 5.597 95% CI [1.064–29.441]; p = 0.042). Moderate renal dysfunction is a powerfull marker of prognosis in PAH.