#2532 Identifying risk factors and protective strategies for pulmonary hypertension in chronic hemodialysis patients

Abstract

Abstract Background and Aims Pulmonary hypertension (PH) is commonly observed and is a predictor of mortality among individuals with end-stage renal disease (ESRD). However, the risk factors associated with PH and its treatment methods have not been thoroughly researched in patients undergoing chronic hemodialysis. Our objective is to investigate the risk factors and explore potential protective measures for PH in patients undergoing chronic hemodialysis. Method From January 1st to December 31st of 2015, 116 patients at a hemodialysis (HD) center met the inclusion criterion of receiving maintenance HD for a minimum of three months. None of the patients met any of the exclusion criteria, which included conditions like chronic obstructive pulmonary disease, interstitial lung disease, or liver cirrhosis. Each of these patients underwent echocardiography and bioimpedance spectroscopy (BIS) the day following their HD session. PH was identified in cases where the pulmonary artery systolic pressure exceeded 35 mmHg. Results Out of the cohort, 17 patients (14.7%) were diagnosed with PH, as shown in Table 1. These patients had fewer prescriptions of calcium channel blockers (CCBs; 5.9% vs. 40.4%, P=0.006) and a higher cardiac–thoracic ratio (CTR; 55% vs. 50%, P=0.04) compared to those without PH. Anthropometric measurements were comparable between the patients with and without PH. BIS revealed a higher extracellular water ratio (13.4% vs. 9.1%, P=0.05) and extracellular-to-intracellular (E/I) body water ratio (1.02 vs. 0.96, P=0.049) in patients with PH. In univariate logistic regression analysis, several factors were associated with PH: CCB prescription [odds ratio (OR) 0.092, 95% confidence interval (CI): 0.011–0.723, P=0.023], interventricular septum thickness (IVS, cm; OR 1.19, 95% CI: 1.046–1.355, P=0.008), ejection fraction (%; OR 0.951, 95% CI: 0.916–0.987, P=0.009), and a higher E/I ratio (>1.03; OR 5.333, 95% CI: 1.055–26.95, P=0.043). In the multivariate regression analysis, CCB prescription (OR 0.027, 95% CI: 0.001–0.478, P=0.014) and IVS (OR 1.333, 95% CI: 1.108–1.605, P=0.002) emerged as the strongest predictors of PH, as detailed in Table 2. Conclusion PH is linked to a lower frequency of CCB prescriptions and structural heart disease. Additionally, fluid overload in the trunk and limbs, as indicated by a higher CTR and E/I water ratio, is also associated with PH. Our study suggests that CCBs could protect against PH in ESRD patients. Additionally, previous research indicating that a subset of PH patients responds well to CCBs [1] suggests that ESRD patients might share similar pathophysiological mechanisms with this subset, further supporting the potential use of CCBs in treating PH among ESRD patients.