Determinants and prognostic value of kidney disease in pulmonary arterial hypertension

This study aimed to assess how right heart hemodynamics are associated with reduced estimated GFR (eGFR), and the association of CKD with survival in PAH patients.In a prospective PAH cohort (2003 to 2012), invasive hemodynamics and eGFR were collected at diagnosis (179 patients), and during follow-up (159 patients). The prevalence of CKD was assessed at PAH diagnosis. Variables, including hemodynamics, associated with reduced eGFR at diagnosis and during follow-up were tested in multivariate analysis. The association of CKD with survival was evaluated in a multivariate Cox regression model.At diagnosis, age was 60.4±16.5 years, mean pulmonary arterial pressure was 43±12 mmHg and eGFR was 74.4±26.4 mL/min/1.73m2. CKD was observed in 52 incident patients (29.1%). Independent determinants of reduced eGFR at diagnosis were age, systemic hypertension and decreased cardiac index. Independent determinants of reduced eGFR during follow-up were age, female gender, PAH etiology, systemic hypertension, decreased cardiac index, and increased right atrial pressures. Age≥60 years, female gender, NYHA 4, and CKD at diagnosis were independently associated with decreased survival. The adjusted hazard ratio for death associated with CKD was 1.81 (95% CI: [1.01; 3.25]).CKD is frequent at PAH diagnosis and is independently associated with increased mortality. Right heart failure may induces renal hypoperfusion and congestion and is associated with eGFR decrease.

Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Cottin, V., Bitker, L., Sens, F., Payet, C., Turquier, S., Traclet, J., Ahmad, K., Zeghmar, S., Mornex, J.-F., Duclos, A., Juillard, L. Tags: Pulmonary hypertension Source Type: research