Abstract
BackgroundPulmonary hypertension (PH) is one of the most common complications associated with end-stage renal disease (ESRD). Though numerous risk factors have been founded, other risk factors remain unidentified, particularly in patients undergoing maintenance hemodialysis with elder age. Soluble Fas (sFas) and its ligand FasL (sFasL) have been reported in chronic renal disease patients; however, they have not been identified in the PH patients of elder hemodialysis patients. We aimed to determine the roles of sFas/sFasL in onset of PH in elder patients undergoing maintenance hemodialysis with ESRD.MethodsAltogether, 163 patients aged 68.00 ± 10.51 years with ESRD who undergoing maintenance hemodialysis in a prospective cohort and were followed-up for a median of 5.5 years. They underwent echocardiography examinations, liver function assessments, residual renal function, and serum ion examinations, before and after dialysis. Furthermore, levels of sFas and sFasL at baseline had also been measured. We compared demographic data, echocardiographic parameters, liver function, ions, and residual renal function as well as serum sFas and sFasL between the PH and non-PH groups. These parameters were correlated with systolic pulmonary artery pressure (sPAP) using Spearman’s correlation. Moreover, univariate and adjusted logistic regression analyses have also been conducted.ResultsThe incidence of PH in the elder dialysis patients was 39.1%. PH populations were demonstrated with significantly higher end-diastolic internal diameters of the left atrium, left ventricle, right ventricle (RV), and pulmonary artery, as well as the left ventricular posterior wall thickness (LVWP; all p < 0.05). A higher baseline serum sFas and sFasL levels have also been identified ( p < 0.001). They also showed lower fractional shortening and left ventricular ejection fraction (LVEF; p < 0.05). Following dialysis, the post-dialysis serum potassium concentration (K+) was significantly higher in the PH group ( p = 0.013). Furthermore, the adjusted regression identified that ratio of sFas/FasL (OR: 1.587, p = 0.004), RV (OR: 1.184, p = 0.014), LVPW (OR: 1.517, p = 0.007), and post-dialysis K+ (OR: 2.717, p = 0.040) was the independent risk factors for PH while LVEF (OR: 0.875, p = 0.040) protects patients from PH.ConclusionThe baseline ratio of sFas/sFasL, RV, LVPW, and post-dialysis K+ was independent risk factors for PH onset, while LVEF was a protective factor for PH.
Highlights
Pulmonary hypertension (PH) is one of the most common complications associated with end-stage renal disease (ESRD)
PH populations were demonstrated with significantly higher end-diastolic internal diameters of the left atrium, left ventricle, right ventricle (RV), and pulmonary artery, as well as the left ventricular Soluble Fas (sFas)/Fas ligand (FasL) Predicts Hemodialysis Patients’ PH
The adjusted regression identified that ratio of sFas/FasL (OR: 1.587, p = 0.004), RV (OR: 1.184, p = 0.014), left ventricular posterior wall (LVPW) (OR: 1.517, p = 0.007), and post-dialysis K+ (OR: 2.717, p = 0.040) was the independent risk factors for PH while left ventricular ejection fraction (LVEF) (OR: 0.875, p = 0.040) protects patients from PH
Summary
Pulmonary hypertension (PH) is one of the most common complications associated with end-stage renal disease (ESRD). Soluble Fas (sFas) and its ligand FasL (sFasL) have been reported in chronic renal disease patients; they have not been identified in the PH patients of elder hemodialysis patients. We aimed to determine the roles of sFas/sFasL in onset of PH in elder patients undergoing maintenance hemodialysis with ESRD. Hemodialysis has been considered as the most used and effective treatments for end-stage renal disease (ESRD) patients (Collins et al, 2001; Zoccali et al, 2004; Li et al, 2014). Pulmonary hypertension (PH) has been identified as one of the most common cardiovascular complications associated with various diseases, including cardiovascular diseases and chronic kidney diseases, and in end-stage renal disease (Barbera et al, 2018; Gumus and Saricaoglu, 2020; Walther et al, 2020; Zhang et al, 2020b). PH is reportedly prevalent in cardiovascular diseases and has been considered the leading cause of right heart failure, which may be fatal (Li et al, 2014; Reque et al, 2016, 2017)
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