Abstract
Introduction: Pulmonary hypertension (PH) is defined as high blood pressure in the lungs. It is recently described as a vascular disease entity in chronic kidney disease, particularly for chronic hemodialysis patients. The aims of this study were to determine the prevalence of PH, to describe clinico-biological and morphological characteristics and to identify risk factors associated with PH in hemodialysis patients. Patients and methods: This is a cross-sectional, descriptive, and analytical study during a period of 8 months from January 1, 2019, to August 31, 2019, in the hemodialysis center of nephrology department of Aristide Le Dantec Hospital. All chronic hemodialysis patients for more than 3 months and with PH confirmed by cardiac doppler ultrasound were included. Results: During the study period, 25/94 patients on chronic hemodialysis, presented with pulmonary hypertension (26.6%). The mean age was 49.3 ± 12.9 years. The sex ratio (M/F) was 0.92. Exertional dyspnea was found in 18 patients (72%). Cardiac auscultation revealed an arrhythmia in 3 patients (12%), augmented second heart sound in 12 patients (48%). On transthoracic doppler ultrasound, pulmonary systolic arterial pressure was on average 51.4 ± 13.2 mmHg. PH was moderate in 13 patients (52%), mild in 9 patients (36%) and severe in 3 patients (12%). The left ventricular ejection fraction was altered in 9 patients (36%). Three patients (12%) had valve calcifications. They were mainly located at aortic valve (8%) and mitral valve (4%). The major risk factors associated to PH in our patients are pathological fractures (p = 0.023), aortic calcifications (p = 0.023), ischemic heart disease (p = 0.023). The duration of hemodialysis represents another favoring factor (p = 0.042). Also implicated are arrhythmias (p = 0.004), high cardiac index (p = 0.043), ventricular dilatation (p = 0.034) and left atrial dilation (p = 0.015), as well as dilation of the inferior vena cava (p = 0.048).
Highlights
Pulmonary hypertension (PH) is defined as high blood pressure in the lungs
The aims of this study were to determine the prevalence of PH, to describe clinico-biological and morphological characteristics and to identify risk factors associated with PH in hemodialysis patients
PH was moderate in 13 patients (52%), mild in 9 patients (36%) and severe in 3 patients (12%)
Summary
Pulmonary hypertension (PH) is defined as high blood pressure in the lungs It is recently described as a vascular disease entity in chronic kidney disease, for chronic hemodialysis patients. Primary PH, whose mechanisms are incompletely known, is a vascular disease entity recently described in chronic kidney disease, for chronic hemodialysis patients It corresponds to the 5th subtype of WSPH classification (World Symposium of Pulmonary Hypertension) established in 2008 at Dana Point [2] and updated in 2013 at Nice [3]. In sub-Saharan Africa, in Senegal in particular, no data on PH in chronic hemodialysis patients by cardiac doppler ultrasound is available Based on this observation, we conducted this study to determine the prevalence of PH in chronic hemodialysis patients, to describe the clinico-biological and morphological characteristics of these patients and to identify the factors associated with the occurrence of this PH
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