Risk Factors of Pulmonary Hypertension in Patients on Hemodialysis: A Single Center Study

Abstract

Introduction: Pulmonary hypertension (PH) is an underestimated cardiovascular consequence and a mortality predictor in patients on hemodialysis (HD). Thus, we studied its prevalence, risk factors, association with inflammation/oxidative stress, and cardiac changes in HD patients. Methods: This was a single-center cross-sectional observational study conducted at a tertiary care hospital. Patients aged > 18 years on hemodialysis for at least three months were included and divided into those with and without PH; patients with secondary causes for PH were excluded. Clinical characteristics, HD-related factors, lab parameters (C-reactive protein and malondialdehyde with thiol assay were used as markers of inflammation and oxidative stress, respectively), and echocardiography details were compared. PH was defined as a mean pulmonary artery pressure of > 25 mmHg at rest, and it was further divided as mild (25– 40 mmHg), moderate (40– 60 mmHg), and severe (> 60 mmHg). Results: Of 52 patients, 28 patients had PH (mild 24, moderate 4, and none had severe PH) with prevalence of 54%. No difference was found in clinical characteristics, dialysis-related factors, biochemical parameters including inflammation (C-reactive protein; p =0.76), or oxidative stress (thiol; p =0.36 and MDA; p =0.46) between the groups. When compared to individuals without PH, HD patients with PH exhibited significantly more mitral regurgitation ( p =0.002). Conclusion: Hemodialysis patients have a high prevalence of PH. PH was significantly associated with the presence of mitral regurgitation on echocardiography. Our study did not find differences in traditional risk factors, HD-related factors, and inflammation/oxidative markers between the groups with and without PH. Keywords: chronic kidney disease, hemodialysis, inflammation, oxidative stress, pulmonary hypertension