Abstract
Introduction and background: In patients with end-stage renal disease (ESRD) and patients on hemodialysis pulmonary hypertention (PH) has been reported. PH is generally mild and the underlying mechanisms remain unclear. Most reports are based on echocardiographic data.
Aims and objectives: To characterize patients with pulmonary hypertension on hemodialysis and identify influencing mechanisms.
Methods: We prospectively studied patients with end stage renal disease on hemodialysis including echocardiography, laboratory tests, ECG, bodyplethysmography, six minute walking test and cardiopulmonary exercise test. If echocardiography showed PH, a right heart catheterization was performed.
Results: In the cohort of 41 patients (63 % male/27% female, BSA 1.8, BMI 26) we found pulmonary hypertension in 17 patients, 24 patients had no signs of PH. Patients with pulmonary hypertension showed significantly more frequently atrial fibrillation (59/13 %, p < 0.05), lower levels of serum creatinine (6.4±3.5/3.9±2.1, p<0.05), higher levels of NT-proBNP (21703 ± 13217/5307 ±3221, p<0,05) and higher levels of parathormone (212.4 ±111.2/378,7 ± 192,8, p<0.05).
Conclusion:The higher incidence of atrial fibrillation in the PH group may either indicate pulmonary venous hypertension or reflect a complication of PH. The lower serum creatinine levels might reflect a more intensive dialysis regimen to manage volume overload or be a consequence of a reduced muscle mass indicating renal cachexia in patients with ESRD and PH. Although NT-pro-BNP-serum levels are affected by impaired renal function itself, levels above 8500 pg/ml may indicate PH. The role of elevated parathormone levels in patients with PH remains unclear.
- © 2014 ERS