Mengyao Tang1, Jonathan A Batty2, Chiayu Lin3, Xiaohong Fan4, Kevin E Chan5, Sahir Kalim6. 1. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA. Electronic address: met721@mail.harvard.edu. 2. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA. 3. Zhejiang University School of Medicine, Hangzhou. 4. Division of Nephrology, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, China. 5. Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston; Fresenius Medical Care NA, Waltham, MA. 6. Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston.
Abstract
BACKGROUND: Pulmonary hypertension is common in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and may be associated with poor outcomes. The magnitude of the association between pulmonary hypertension and mortality is uncertain due to the small size and variable findings of observational studies. STUDY DESIGN: Systematic review and meta-analysis of observational studies using subgroup analyses and metaregression. SETTING & POPULATION: Patients with ESRD or earlier stages of CKD. SELECTION CRITERIA FOR STUDIES: Observational studies reporting clinical outcomes in patients with co-existing pulmonary hypertension and CKD or ESRD identified using a systematic search of PubMed and Embase. PREDICTOR: Pulmonary hypertension diagnosed by Doppler echocardiography. OUTCOMES: All-cause mortality, cardiovascular mortality, and cardiovascular events. RESULTS: 16 studies, with 7,112 patients with an overall pulmonary hypertension prevalence of 23%, were included. Pulmonary hypertension was associated with increased risk for all-cause mortality among patients with CKD (relative risk [RR], 1.44; 95% CI, 1.17-1.76), with ESRD receiving maintenance dialysis (RR, 2.32; 95% CI, 1.91-2.83), and with a functioning kidney transplant (RR, 2.08; 95% CI, 1.35-3.20). Pulmonary hypertension was associated with increased risk for cardiovascular events in patients with CKD (RR, 1.67; 95% CI, 1.07-2.60) and ESRD receiving dialysis (RR, 2.33; 95% CI, 1.76-3.08). There was an association between pulmonary hypertension and increased risk for cardiovascular mortality in patients with CKD or ESRD (RR, 2.20; 95% CI, 1.53-3.15). LIMITATIONS: Heterogeneity of included studies, possibility of residual confounding, unavailability of individual patient-level data, and possibility of outcome reporting bias. CONCLUSIONS: Pulmonary hypertension is associated with a substantially increased risk for death and cardiovascular events in patients with CKD and ESRD. Risk is higher in patients with ESRD receiving dialysis compared with patients with CKD stages 1 to 5. Understanding the effect of interventions to lower pulmonary artery pressure on the survival of these patents awaits their evaluation in randomized controlled trials.
BACKGROUND:Pulmonary hypertension is common in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and may be associated with poor outcomes. The magnitude of the association between pulmonary hypertension and mortality is uncertain due to the small size and variable findings of observational studies. STUDY DESIGN: Systematic review and meta-analysis of observational studies using subgroup analyses and metaregression. SETTING & POPULATION: Patients with ESRD or earlier stages of CKD. SELECTION CRITERIA FOR STUDIES: Observational studies reporting clinical outcomes in patients with co-existing pulmonary hypertension and CKD or ESRD identified using a systematic search of PubMed and Embase. PREDICTOR: Pulmonary hypertension diagnosed by Doppler echocardiography. OUTCOMES: All-cause mortality, cardiovascular mortality, and cardiovascular events. RESULTS: 16 studies, with 7,112 patients with an overall pulmonary hypertension prevalence of 23%, were included. Pulmonary hypertension was associated with increased risk for all-cause mortality among patients with CKD (relative risk [RR], 1.44; 95% CI, 1.17-1.76), with ESRD receiving maintenance dialysis (RR, 2.32; 95% CI, 1.91-2.83), and with a functioning kidney transplant (RR, 2.08; 95% CI, 1.35-3.20). Pulmonary hypertension was associated with increased risk for cardiovascular events in patients with CKD (RR, 1.67; 95% CI, 1.07-2.60) and ESRD receiving dialysis (RR, 2.33; 95% CI, 1.76-3.08). There was an association between pulmonary hypertension and increased risk for cardiovascular mortality in patients with CKD or ESRD (RR, 2.20; 95% CI, 1.53-3.15). LIMITATIONS: Heterogeneity of included studies, possibility of residual confounding, unavailability of individual patient-level data, and possibility of outcome reporting bias. CONCLUSIONS:Pulmonary hypertension is associated with a substantially increased risk for death and cardiovascular events in patients with CKD and ESRD. Risk is higher in patients with ESRD receiving dialysis compared with patients with CKD stages 1 to 5. Understanding the effect of interventions to lower pulmonary artery pressure on the survival of these patents awaits their evaluation in randomized controlled trials.
Authors: Daniel L Edmonston; Kishan S Parikh; Sudarshan Rajagopal; Linda K Shaw; Dennis Abraham; Alexander Grabner; Matthew A Sparks; Myles Wolf Journal: Am J Kidney Dis Date: 2019-11-12 Impact factor: 8.860
Authors: Gabrielle Costa Borba; Francini Porcher Andrade; Tatiane de Souza Ferreira; Antônio Fernando Furlan Pinotti; Francisco Veríssimo Veronese; Paula Maria Eidt Rovedder Journal: Int Urol Nephrol Date: 2022-09-29 Impact factor: 2.266
Authors: Yu Ni; Claire L Simpson; Robert L Davis; Adam A Szpiro; Catherine J Karr; Csaba P Kovesdy; Rebecca C Hjorten; Frances A Tylavsky; Nicole R Bush; Kaja Z LeWinn; Cheryl A Winkler; Jeffrey B Kopp; Yoshitsugu Obi Journal: Environ Res Date: 2022-03-28 Impact factor: 8.431
Authors: Sankar D Navaneethan; Carl P Walther; L Parker Gregg; Shweta Bansal; Wolfgang C Winkelmayer; Vijay Nambi; Jingbo Niu Journal: Am J Kidney Dis Date: 2021-04-24 Impact factor: 8.860
Authors: Bak Leong Goh; Malini Shanmuganathan; Kalaiarasu Peariasamy; Nor Arisah Misnan; Suresh Kumar Chidambaram; Eddie Fook Sem Wong; Mohan Dass Pathmanathan; Kim Liong Ang; Hin Seng Wong; Lena Lay Ling Yeap Journal: Nephrology (Carlton) Date: 2022-05-07 Impact factor: 2.358
Authors: Melissa C Caughey; Randal K Detwiler; Joseph A Sivak; Lisa J Rose-Jones; Abhijit V Kshirsagar; Alan L Hinderliter Journal: Transplantation Date: 2020-10 Impact factor: 5.385