Clinical study of pulmonary hypertension in various stages of chronic kidney disease at a tertiary care center

 

 

Abstract              Background: Pulmonary arterial hypertension (PAH) is increasingly recognized disease in patients with renal disease. In a review, the prevalence of PHT in ESRD patients was reported to be around 40–50%. Potential mechanisms for the development of PH in patients with CKD include endothelial dysfunction, increased flow through arterio-venous shunts, exposure to dialysis membranes, and elevated left ventricular filling pressure. Due to such increasing incidence of PH in CKD, present study was aimed to study pulmonary hypertension in various stages of chronic kidney disease at a tertiary care center. Material and Methods: Present cross-sectional and prospective study was conducted in Department of nephrology in patients with chronic kidney disease, diagnosed with pulmonary hypertension, willing for follow-up and participation in present study. Results: In present study, total 162 patients were included. Mean age in years was 45.19±13.26, while range of age was 19-76 years. Male patients (70%) outnumbered female patients. Co-morbidities in present study were anemia (78 %), systolic hypertension (28 %), diastolic hypertension ( 23%), diabetes mellitus ( 55%). Pulmonary hypertension was present in 66 (41 %) patients. In patients with pulmonary hypertension most common etiology for CKD were diabetes mellitus (41%), hypertension (32%), undetermined (6%), chronic tubulointerstitial disease (6%).In present study 28, 72 and 68 patients had CKD stage 3,4 and 5 respectively. Out of 66 patients with pulmonary hypertension 7, 23 and 36 patients had CKD stage 3,4 and 5 respectively. 45, 15 and 6 patients with pulmonary hypertension had mild (< 45 mph) ,moderate (45 - 60 mm hg) and severe (> 60 mm hg) pulmonary hypertension respectively. We compared few biochemical variables with pulmonary hypertension. P value was statistically significant in Hb <10 gm/dl and Ca × P product >55 mg2/dl2 patients. Total 90 patients were receiving hemodialysis in present study. Pulmonary hypertension was present in 43%,59% and 87% patients receiving hemodialysis for duration of < 6 months, 6 12 months and >12 months respectively. P value was statistically significant. Conclusion: In patients with CKD, presence of anemia, volume overload and increased calcium phosphate product can induce or aggravate pulmonary hypertension. In patients with hypertension and diabetes mellites, pulmonary hypertension is seen commonly.

Key Words: chronic kidney disease, haemodialysis, pulmonary hypertension, Calcium phosphate product