Abstract
Objective: Pulmonary hypertension (PH) has been described in hemodialysis (HD) patients and has been associated with increased morbidity and mortality. Our objective was to determine the prevalence of pulmonary hypertension in patients on regular hemodialysis. Methods: This cross sectional study was conducted in Department of Nephrology, Liaquat National Hospital Karachi from April 2013 to March 2014. Eighty patients of end stage renal disease (ESRD), on maintenance hemodialysis (HD); underwent Trans thoracic Echocardiography were selected. Systolic pulmonary arterial pressure (SPAP) was recorded. Pulmonary hypertension was defined as, pulmonary artery pressure (PAP) greater than 30 mm Hg at rest. Pulmonary hypertension was further divided into mild (PAP b/w 30-45mmHg), moderate (PAP b/w 45-65mmHg) and severe pulmonary hypertension (PAP > 65mmHg). The effect of different vascular accesses, age, gender, dialysis vintage on the development of pulmonary hypertension was observed. Results: Out of 80 patients, 45 patients (56%) had pulmonary hypertension (PH); 25(55.5%) had moderate, 13(29%) had mild, and 7 (15.5%) patients had severe pulmonary hypertension (PH). Pulmonary hypertension was present in 41(60%) patients with AVF, 3(27%) patients with tunnel cuffed catheter and 1 patient had AV bridge graft. Pulmonary hypertension was more common in females; present in 28 females (67%) and 17 males (45%), that was statistically significant (p<0.05). Mean duration of hemodialysis in (months) of patients with PH was 20.93 ± 12 vs. 10.29 ±10 in patients without PH (p<0.05). Age had no relation to development of PH. Conclusion: ESRD patients on HD have strong tendency to develop PH. Our study demonstrated that PH is more common among females. Duration of hemodialysis and AV access has strong relation to the development of PH.
Highlights
Pulmonary hypertension (PH) is defined as systolic pulmonary arterial pressure (SPAP) greater than 30 mm Hg at rest determined by Doppler echocardiography.[1]
Echocardiography was performed post dialysis when patients were at optimal dry weight
We studied the effect of various other hemodialysis access on the development of PH including patients with permanent catheters and AV bridge graft
Summary
Pulmonary hypertension (PH) is defined as systolic pulmonary arterial pressure (SPAP) greater than 30 mm Hg at rest determined by Doppler echocardiography.[1] Chronic kidney disease (CKD) is a challenging issue for health care providers and major burden for health care. Cardiovascular disease is a well-recognized and important source of mortality in patients with chronic kidney diseas.[2,3,4] It accounts for approximately 50 percent of deaths in dialysis patients.[5] Aside from coronary artery disease, other forms of cardiovascular disease are prevalent in chronic kidney disease. Pulmonary hypertension (PH) has been described in hemodialysis patients.[6,7] It is a progressive disorder with increased morbidity and mortality.[8] Yigle et al in the study reported a significantly lower survival rate in HD patients with PH with their counterparts without PH.[9]
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