Researchers from Korea University Anam Hospital found a higher prevalence of pulmonary hypertension (PHT) associated with higher rates of major cardiovascular events in end-stage renal disease (ESRD) patients undergoing hemodialysis. The study entitled “Relationship between pulmonary hypertension, peripheral vascular calcification, and major cardiovascular events in dialysis patients” was published on March 2015 in the journal Kidney Research and Clinical Practice.
Pulmonary hypertension (PHT) is caused by increased blood pressure in lung vasculature, leading to severe disease characterized by decreased exercise tolerance and heart failure. PHT was recently identified in ESRD patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). This study further investigated the association between PHT and peripheral vascular calcifications (VC), and major cardiovascular events in 172 ESRD patients undergoing dialysis for an average of 35.0 months. Using echocardiography as a noninvasive method, researchers diagnosed PHT in 36.6% of patients. In accordance with other studies, the prevalence of PHT was significantly higher in HD patients in comparison to PD patients (51.2% vs. 22.7%). PHT was a predictor of major cardiovascular events such as acute myocardial infarction or stroke in dialysis patients. The precise mechanisms leading to increased cardiovascular events in dialysis patients with PHT are unclear, there is a possibility that extraosseous calcification, a well-known risk factor for cardiovascular disease may play a role in PHT development. The higher prevalence of severe peripheral VC observed in patients with PHT further suggest that the mechanisms underlying the development of chronic kidney disease-mineral bone disorder might be partially responsible for PHT.
This study enrolled only a limited number of patients with relatively short follow-up period in a single center, but the results obtained indicate that there is a relationship between PHT, peripheral VCs, and cardiovascular disease in ESRD patients that should be carefully considered. The underlying mechanisms remain to be further elucidated.
“The prevalence of PHT was higher in HD patients. Severe VCs are thought to be an independent risk factor for predicting PHT in ESRD patients. Therefore, in dialysis patients with PHT, careful attention should be paid to the presence of VCs and the occurrence of major cardiovascular events,” concluded the authors of the study.