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01-06-2020 | Transthoracic Echocardiography | PULMONARY HYPERTENSION

Prevalence and Mortality of Pulmonary Hypertension in ESRD: A Systematic Review and Meta-analysis

Authors: Noah C. Schoenberg, Rahul G. Argula, Elizabeth S. Klings, Kevin C. Wilson, Harrison W. Farber

Published in: Lung | Issue 3/2020

Abstract

Introduction

Pulmonary hypertension (PH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PH among patients with ESRD and compared mortality between ESRD patients with and without PH.

Methods

Two independent reviewers searched three databases using a search strategy built around the medical subject headings of “hypertension, pulmonary” and “kidney failure, chronic.” Keywords and synonyms were also used. Study selection criteria included (1) Enrollment of patients with ESRD undergoing hemodialysis or peritoneal dialysis, (2) Assessment for the presence of PH using transthoracic echocardiography, and (3) Determination of PH prevalence or associated mortality. The primary outcomes were prevalence of PH or associated mortality. The Grading, Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence.

Results

The initial search identified 1046 publications, from which 41 studies were selected. The median prevalence of PH identified by echocardiographic criteria among patients with ESRD was 38% (range 8% to 70%), and was significantly increased in patients undergoing hemodialysis (HD) (median 40%, range 16–70%) as compared with peritoneal dialysis (PD) (median 19%, range 8–37%). Meta-analysis demonstrated that overall mortality was higher among ESRD patients with echocardiographic evidence of PH than ESRD patients without echocardiographic evidence of PH (RR 2.02; 95% CI 1.70–2.40).

Conclusions

Echocardiographic evidence of PH is common among ESRD patients undergoing dialysis and associated with increased mortality. Identification of those patients with evidence of pulmonary hypertension on transthoracic echocardiography may warrant further evaluation and treatment.

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Simonneau G, Montani D, Celermajer DS et al. (2019) Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Resp J. 53:1801913. https://doi.org/10.1183/13993003.01913-2018]10.1016/j.jacc.2013.10.029 CrossRef

Yigla M, Nakhoul F, Sabag A et al. (2003) Pulmonary hypertension in patients with end-stage renal disease. Chest 123(5):1577–1582CrossRef

Sise ME, Courtwright AM, Channick RN (2013) Pulmonary hypertension in patients with chronic and end-stage kidney disease. Kidney Int 84(4):682–692. https://doi.org/10.1038/ki.2013.186 CrossRefPubMed

United States Renal Data System. 2018 USRDS annual data report: executive summary. https://www.usrds.org/2018/view/v1_00.aspx.

The Cochrane Collaboration (2014) Review manager (RevMan) [computer program]

Balshem H, Helfand M, Schunemann HJ et al. (2011) GRADE guidelines: 3, rating the quality of evidence. J Clin Epidemiol 64(4):401–406. https://doi.org/10.1016/j.jclinepi.2010.07.015 CrossRefPubMed

Stewart LA, Clarke M, Rovers M et al. (2015) Preferred reporting items for systematic review and meta-analyses of individual participant data: the PRISMA-IPD statement. JAMA 313(16):1657–1665. https://doi.org/10.1001/jama.2015.3656 CrossRefPubMed

Abdelwhab S, Elshinnawy S (2008) Pulmonary hypertension in chronic renal failure patients. Am J Nephrol 28(6):990–997. https://doi.org/10.1159/000146076 CrossRefPubMed

Abedini M, Sadeghi M, Naini AE, Atapour A, Golshahi J (2013) Pulmonary hypertension among patients on dialysis and kidney transplant recipients. Ren Fail 35(4):560–565. https://doi.org/10.3109/0886022X.2013.766567 CrossRefPubMed

10.

Acarturk G, Albayrak R, Melek M et al. (2008) The relationship between arteriovenous fistula blood flow rate and pulmonary artery pressure in hemodialysis patients. Int Urol Nephrol 40(2):509–513. https://doi.org/10.1007/s11255-007-9269-8 CrossRefPubMed

11.

Agarwal R (2012) Prevalence, determinants and prognosis of pulmonary hypertension among hemodialysis patients. Nephrol Dial Transplant 27(10):3908–3914. https://doi.org/10.1093/ndt/gfr661 CrossRefPubMedPubMedCentral

12.

Alhamad EH, Al-Ghonaim M, Alfaleh HF, Cal JP, Said N (2014) Pulmonary hypertension in end-stage renal disease and post renal transplantation patients. J Thorac Dis 6(6):606–616. https://doi.org/10.3978/j.issn.2072-1439.2014.04.29 CrossRefPubMedPubMedCentral

13.

Amin M, Fawzy A, Hamid MA, Elhendy A (2003) Pulmonary hypertension in patients with chronic renal failure: role of parathyroid hormone and pulmonary artery calcifications. Chest 124(6):2093–2097CrossRef

14.

Dagli CE, Sayarlioglu H, Dogan E et al. (2009) Prevalence of and factors affecting pulmonary hypertension in hemodialysis patients. Respiration 78(4):411–415. https://doi.org/10.1159/000247334 CrossRefPubMed

15.

Etemadi J, Zolfaghari H, Firoozi R et al. (2012) Unexplained pulmonary hypertension in peritoneal dialysis and hemodialysis patients. Rev Port Pneumol 18(1):10–14. https://doi.org/10.1016/j.rppneu.2011.07.002 CrossRefPubMed

16.

Fabbian F, Cantelli S, Molino C, Pala M, Longhini C, Portaluppi F (2010) Pulmonary hypertension in dialysis patients: A cross-sectional italian study. Int J Nephrol 2011:283475. https://doi.org/10.4061/2011/283475 CrossRefPubMedPubMedCentral

17.

Fadaii A, Koohi-Kamali H, Bagheri B, Hamidimanii F, Taherkhanchi B (2013) Prevalence of pulmonary hypertension in patients undergoing hemodialysis. Iran J Kidney Dis 7(1):60–63PubMed

18.

Faqih SA, Noto-Kadou-Kaza B, Abouamrane LM et al. (2016) Pulmonary hypertension: prevalence and risk factors. Int J Cardiol Heart Vasc 11:87–89. https://doi.org/10.1016/j.ijcha.2016.05.012 CrossRefPubMedPubMedCentral

19.

Genctoy G, Arikan S, Eldem O (2015) Pulmonary hypertension associates with malnutrition and body composition hemodialysis patients. Ren Fail 37(2):273–279. https://doi.org/10.3109/0886022X.2014.986705 CrossRefPubMed

20.

Hassanin N, Alkemary A (2016) Evaluation of pulmonary artery pressure and resistance by pulsed doppler echocardiography in patients with end-stage renal disease on dialysis therapy. J Saudi Heart Assoc 28(2):101–112. https://doi.org/10.1016/j.jsha.2015.09.002 CrossRefPubMed

21.

Hayati F, Beladi Mousavi SS, Mousavi Movahed SM, Mofrad BM (2016) Pulmonary hypertension among patients undergoing hemodialysis. J Renal Inj Prev 6(2):122–126. https://doi.org/10.15171/jrip.2017.24 CrossRefPubMedPubMedCentral

22.

He Y, Wang Y, Luo X, Ke J, Du Y, Li M (2015) Risk factors for pulmonary hypertension in maintenance hemodialysis patients: a cross-sectional study. Int Urol Nephrol 47(11):1889–1897. https://doi.org/10.1007/s11255-015-1119-5 CrossRefPubMed

23.

Kim SC, Chang HJ, Kim MG, Jo SK, Cho WY, Kim HK (2015) Relationship between pulmonary hypertension, peripheral vascular calcification, and major cardiovascular events in dialysis patients. Kidney Res Clin Pract 34(1):28–34. https://doi.org/10.1016/j.krcp.2015.01.003 CrossRefPubMedPubMedCentral

24.

Kiykim AA, Horoz M, Ozcan T, Yildiz I, Sari S, Genctoy G (2010) Pulmonary hypertension in hemodialysis patients without arteriovenous fistula: The effect of dialyzer composition. Ren Fail 32(10):1148–1152. https://doi.org/10.3109/0886022X.2010.516854 CrossRefPubMed

25.

Li Z, Liang X, Liu S et al. (2014) Pulmonary hypertension: Epidemiology in different CKD stages and its association with cardiovascular morbidity. PLoS ONE 9(12):e114392. https://doi.org/10.1371/journal.pone.0114392 CrossRefPubMedPubMedCentral

26.

Li Z, Liu S, Liang X et al. (2014) Pulmonary hypertension as an independent predictor of cardiovascular mortality and events in hemodialysis patients. Int Urol Nephrol 46(1):141–149. https://doi.org/10.1007/s11255-013-0486-z CrossRefPubMed

27.

Mahdavi-Mazdeh M, Alijavad-Mousavi S, Yahyazadeh H, Azadi M, Yoosefnejad H, Ataiipoor Y (2008) Pulmonary hypertension in hemodialysis patients. Saudi J Kidney Dis Transpl 19(2):189–193PubMed

28.

Mukhtar KN, Mohkumuddin S, Mahmood SN (2014) Frequency of pulmonary hypertension in hemodialysis patients. Pak J Med Sci 30(6):1319–1322. https://doi.org/10.12669/pjms.306.5525 CrossRefPubMedPubMedCentral

29.

Nakhoul F, Yigla M, Gilman R, Reisner SA, Abassi Z (2005) The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol Dial Transplant 20(8):1686–1692CrossRef

30.

Omrani H, Golshani S, Sharifi V, Almasi A, Sadeghi M (2016) The relationship between hemodialysis and the echocardiographic findings in patients with chronic kidney disease. Med Arch 70(5):328–331. https://doi.org/10.5455/medarh.2016.70.328-331 CrossRefPubMedPubMedCentral

31.

Oygar DD, Zekican G (2012) Pulmonary hypertension in dialysis patients. Ren Fail 34(7):840–844. https://doi.org/10.3109/0886022X.2012.690715 CrossRefPubMed

32.

Ramasubbu K, Deswal A, Herdejurgen C, Aguilar D, Frost AE (2010) A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the united states: Prevalence and clinical significance. Int J Gen Med 3:279–286. https://doi.org/10.2147/IJGM.S12946 CrossRefPubMedPubMedCentral

33.

Reque J, Quiroga B, Ruiz C et al. (2016) Pulmonary hypertension is an independent predictor of cardiovascular events and mortality in haemodialysis patients. Nephrology (Carlton) 21(4):321–326. https://doi.org/10.1111/nep.12595 CrossRef

34.

Shen S, Sun Q (2015) Analysis of clinically relevant factors for pulmonary hypertension in maintenance hemodialysis patients. Med Sci Monit 21:4050–4056CrossRef

35.

Tarrass F, Benjelloun M, Medkouri G, Hachim K, Benghanem MG, Ramdani B (2006) Doppler echocardiograph evaluation of pulmonary hypertension in patients undergoing hemodialysis. Hemodial Int 10(4):356–359CrossRef

36.

Unal A, Duran M, Tasdemir K et al. (2013) Does arterio-venous fistula creation affects development of pulmonary hypertension in hemodialysis patients? Ren Fail 35(3):344–351. https://doi.org/10.3109/0886022X.2012.760407 CrossRefPubMed

37.

Unal A, Sipahioglu M, Oguz F et al. (2009) Pulmonary hypertension in peritoneal dialysis patients: Prevalence and risk factors. Perit Dial Int 29(2):191–198CrossRef

38.

Xu Q, Xiong L, Fan L et al. (2015) Association of pulmonary hypertension with mortality in incident peritoneal dialysis patients. Perit Dial Int 35(5):537–544. https://doi.org/10.3747/pdi.2013.00332 CrossRefPubMedPubMedCentral

39.

Yigla M, Fruchter O, Aharonson D et al. (2009) Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Int 75(9):969–975. https://doi.org/10.1038/ki.2009.10 CrossRefPubMed

40.

Yigla M, Keidar Z, Safadi I, Tov N, Reisner SA, Nakhoul F (2004) Pulmonary calcification in hemodialysis patients: Correlation with pulmonary artery pressure values. Kidney Int 66(2):806–810. https://doi.org/10.1111/j.1523-1755.2004.00807.x CrossRefPubMed

41.

Yilmaz S, Yildirim Y, Taylan M et al. (2016) The relationship of fluid overload as assessed by bioelectrical impedance analysis with pulmonary arterial hypertension in hemodialysis patients. Med Sci Monit 22:488–494CrossRef

42.

Yoo HH, Martin LC, Kochi AC et al. (2012) Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension? BMC Nephrol 13:80–2369. https://doi.org/10.1186/1471-2369-13-80 CrossRefPubMedPubMedCentral

43.

Yoo HHB, Dos Reis R, Telini WM et al. (2017) Association of pulmonary hypertension with inflammation and fluid overload in hemodialysis patients. Iran J Kidney Dis 11(4):303–308PubMed

44.

Yu TM, Chen YH, Hsu JY et al. (2009) Systemic inflammation is associated with pulmonary hypertension in patients undergoing haemodialysis. Nephrol Dial Transplant 24(6):1946–1951. https://doi.org/10.1093/ndt/gfn751 CrossRefPubMed

45.

Zeng Y, Yang DD, Feng S et al. (2016) Risk factors for pulmonary hypertension in patients receiving maintenance peritoneal dialysis. Braz J Med Biol Res. https://doi.org/10.1590/1414-431X20154733 CrossRefPubMedPubMedCentral

46.

Zhang L, Zhao S, Ma J et al. (2016) Prevalence and risk factors for pulmonary arterial hypertension in end-stage renal disease patients undergoing continuous ambulatory peritoneal dialysis. Ren Fail 38(5):815–821. https://doi.org/10.3109/0886022X.2015.1103637 CrossRefPubMed

47.

Zhao LJ, Huang SM, Liang T, Tang H (2014) Pulmonary hypertension and right ventricular dysfunction in hemodialysis patients. Eur Rev Med Pharmacol Sci 18(21):3267–3273PubMed

48.

Bozbas SS, Akcay S, Altin C et al. (2009) Pulmonary hypertension in patients with end-stage renal disease undergoing renal transplantation. Transplant Proc 41(7):2753–2756. https://doi.org/10.1016/j.transproceed.2009.07.049 CrossRefPubMed

49.

Casas-Aparicio G, Castillo-Martinez L, Orea-Tejeda A, Abasta-Jimenez M, Keirns-Davies C, Rebollar-Gonzalez V (2010) The effect of successful kidney transplantation on ventricular dysfunction and pulmonary hypertension. Transplant Proc 42(9):3524–3528. https://doi.org/10.1016/j.transproceed.2010.06.026 CrossRefPubMed

50.

Issa N, Krowka MJ, Griffin MD, Hickson LJ, Stegall MD, Cosio FG (2008) Pulmonary hypertension is associated with reduced patient survival after kidney transplantation. Transplantation 86(10):1384–1388. https://doi.org/10.1097/TP.0b013e318188d640 CrossRefPubMed

51.

Reddy YN, Lunawat D, Abraham G et al. (2013) Progressive pulmonary hypertension: Another criterion for expeditious renal transplantation. Saudi J Kidney Dis Transpl 24(5):925–929CrossRef

52.

Stallworthy EJ, Pilmore HL, Webster MW et al. (2013) Do echocardiographic parameters predict mortality in patients with end-stage renal disease? Transplantation 95(10):1225–1232. https://doi.org/10.1097/TP.0b013e31828dbbbe CrossRefPubMed

53.

Moreira EM, Gall H, Leening MJ et al. (2015) Prevalence of pulmonary hypertension in the general population: The rotterdam study. PLoS ONE 10(6):e0130072. https://doi.org/10.1371/journal.pone.0130072 CrossRefPubMedPubMedCentral

54.

Tang M, Batty JA, Lin C, Fan X, Chan KE, Kalim S (2018) Pulmonary hypertension, mortality, and cardiovascular disease in CKD and ESRD patients: a systematic review and meta-analysis. Am J Kidney Dis 72(1):75–83CrossRef

55.

Nishimura M, Tokoro T, Yamazaki S, Hashimoto T, Kobayashi H, Ono T (2017) Idiopathic pre-capillary pulmonary hypertension in patients with end-stage kidney disease: Effect of endothelin receptor antagonists. Clin Exp Nephrol 21(6):1088–1096. https://doi.org/10.1007/s10157-016-1344-y CrossRefPubMed

56.

O'Leary JM, Assad TR, Xu M, Birdwell KA, Farber-Eger E, Wells QS, Hemnes AR, Brittain EL (2017) Pulmonary hypertension in patients with chronic kidney disease: invasive hemodynamic etiology and outcomes. Pulm Circ 7(3):674–683CrossRef

57.

Edmonston DL, Parikh KS, Rajagopal S, Shaw LK, Abraham D, Grabner A, Sparks MA, Wolf M (2019) Pulmonary hypertension subtypes and mortality in CKD. Am J Kidney Dis. https://doi.org/10.1053/j.ajkd.2019.08.027 CrossRefPubMed

58.

O'Leary JM, Assad TR, Xu M, Farber-Eger E, Wells QS, Hemnes AR, Brittain EL (2018) Lack of a tricuspid regurgitation doppler signal and pulmonary hypertension by invasive measurement. J Am Heart Assoc. 7(13):e009362CrossRef

Title: Prevalence and Mortality of Pulmonary Hypertension in ESRD: A Systematic Review and Meta-analysis
Authors: Noah C. Schoenberg
Rahul G. Argula
Elizabeth S. Klings
Kevin C. Wilson
Harrison W. Farber
Publication date: 01-06-2020
Publisher: Springer US
Keywords: Transthoracic Echocardiography
Peritoneal Dialysis
Pulmonary Hypertension
Pulmonary Hypertension
Pulmonary Hypertension
Pulmonary Hypertension
Published in: Lung / Issue 3/2020
Print ISSN: 0341-2040
Electronic ISSN: 1432-1750
DOI: https://doi.org/10.1007/s00408-020-00355-0

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