HDCN Abstract:  ASN Annual Meeting -- San Francisco  

Usmani AB, Mittman N, Myint T, et al.

Pulmonary Hypertension (PH) and Pulmonary Artery Pressure (PAP) Predict Survival in Hemodialysis (HD) Patients (Pts).

ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:714A 2007

Pulmonary hypertension (PH) is defined as elevated PAP (>30 mmHg) and increased pulmonary vascular resistance. We have previously reported that PH is highly prevalent and may affect outcomes in HD pts.

The objective of this longitudinal study was to investigate the relationship between PH and mortality in a large number of HD pts. From 2002 to 2007, we screened 511 HD pts attending our outpatient center. Demographic and clinical data, including echocardiographic findings (ECHO), and survival data were collected by chart review. Pts were followed to May 2007, up to 7 years from the date of ECHO. Mean age was 6114 (SD) years. Fifty-three percent were male and 70% were African American. Out of 511 pts screened, 330 pts had ECHO available. Of those pts with ECHO done, 209 pts (64%) had PH (PAP>30 mm Hg). The minimum prevalence of PH in this population was 41%, assuming that all pts who did not have any ECHO did not have PH. PAP directly correlated (r= 0.18; p=0.005) with age, but was not affected by gender (p=0.52), race (p=0.18) nor diabetic status (p=0.66). Mean PAP in PH pts was 46.412 mm Hg. Fifty eight pts (17.5% of pts with ECHO) had moderately severe to severe PH, ie PAP>50 mm Hg. Pts who survived during the study period had significantly lower PAP compared to that of those who did not survive (39.9 vs. 48.6 mm Hg, p<0.0001).

The cumulative observed survival (Kaplan Meier) of pts with enrollment PAP>50 mm Hg was significantly (p=0.03) lower than that of pts with PAP50 mm Hg. By multivariate logistic regression analysis, after adjusting for age, race, gender and diabetic status, PAP was significantly associated with mortality in HD pts (odds ratio, 1.043, p=0.008). In multivariate Coxs regression analysis, PAP was an independent predictor of mortality (RR=1.031, p=0.04).

Therefore, for each mm Hg increase in PH, there was a 3% increase in mortality risk. In conclusion, PH is highly prevalent and is associated with increased mortality risk in HD pts. The use of PAP as a mortality predictor to timely diagnose PH may enable early intervention.

© Copyright 2007-2008, American Society of Nephrology. Reproduced with permission.
Until September of 2008, all ASN abstracts from the 2007 Annual Meeting are available at this link

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