Laurent Bitker1, Florence Sens1,2,3,4, Cécile Payet3,4, Ségolène Turquier5, Antoine Duclos3,4, Vincent Cottin5,6, Laurent Juillard1,2,7. 1. Nephrology Department, Edouard Herriot Academic Hospital, Hospices Civils de Lyon, Lyon, France. 2. Cardiovascular and Renal Clinical Trialists Network (F-CRIN INI-CRCT), Nancy, France. 3. Pôle Information Médicale, Evaluation, Recherche (IMER), Hospices Civils de Lyon, Lyon, France. 4. Health Service and Performance Research (HESPER), EA 7425, Université de Lyon, Lyon, France. 5. Department of Respiratory Diseases, Louis Pradel Hospital, National Reference Centre for Rare Pulmonary Diseases, Regional Competence Center for Severe Pulmonary Arterial Hypertension, Hospices Civils de Lyon, Lyon, France. 6. INRA, UMR754, IFR 128, Université Lyon 1 Claude Bernard, Lyon, France. 7. Cardiovasculaire Métabolisme Diabétologie et Nutrition (CarMeN), INSERM U1060, INRA 1235, Université Lyon 1 Claude Bernard, Lyon, France.
Abstract
BACKGROUND: Pulmonary arterial hypertension (PAH) may lead to right heart failure and subsequently alter glomerular filtration rates (GFR). Chronic kidney disease (CKD, GFR <60 mL/min/1.73 m2) may also adversely affect PAH prognosis. This study aimed to assess how right heart hemodynamics was associated with reduced estimated GFR (eGFR) and the association of CKD with survival in PAH patients. METHODS: In a prospective PAH cohort (2003-2012), invasive hemodynamics and eGFR were collected at diagnosis (179 patients) and during follow-up (159 patients). The prevalence of CKD was assessed at PAH diagnosis. Variables, including hemodynamics, associated with reduced eGFR at diagnosis and during follow-up were tested in multivariate analysis. The association of CKD with survival was evaluated using a multivariate Cox regression model. RESULTS: At diagnosis, mean age was 60.4 ± 16.5 years, mean pulmonary arterial pressure was 43 ± 12 mm Hg, and eGFR was 74.4 ± 26.4 mL/min/1.73 m2. CKD was observed in 52 incident patients (29%). Independent determinants of reduced eGFR at diagnosis were age, systemic hypertension, and decreased cardiac index. Independent determinants of reduced eGFR during follow-up were age, female gender, PAH etiology, systemic hypertension, decreased cardiac index, and increased right atrial pressure. Age ≥60 years, female gender, NYHA 4, and CKD at diagnosis were independently associated with decreased survival. The adjusted hazards ratio for death associated with CKD was 1.81 (95% confidence interval [1.01-3.25]). CONCLUSION: CKD is frequent at PAH diagnosis and is independently associated with increased mortality. Right heart failure may induce renal hypoperfusion and congestion, and is associated with eGFR decrease.
BACKGROUND:Pulmonary arterial hypertension (PAH) may lead to right heart failure and subsequently alter glomerular filtration rates (GFR). Chronic kidney disease (CKD, GFR <60 mL/min/1.73 m2) may also adversely affect PAH prognosis. This study aimed to assess how right heart hemodynamics was associated with reduced estimated GFR (eGFR) and the association of CKD with survival in PAH patients. METHODS: In a prospective PAH cohort (2003-2012), invasive hemodynamics and eGFR were collected at diagnosis (179 patients) and during follow-up (159 patients). The prevalence of CKD was assessed at PAH diagnosis. Variables, including hemodynamics, associated with reduced eGFR at diagnosis and during follow-up were tested in multivariate analysis. The association of CKD with survival was evaluated using a multivariate Cox regression model. RESULTS: At diagnosis, mean age was 60.4 ± 16.5 years, mean pulmonary arterial pressure was 43 ± 12 mm Hg, and eGFR was 74.4 ± 26.4 mL/min/1.73 m2. CKD was observed in 52 incident patients (29%). Independent determinants of reduced eGFR at diagnosis were age, systemic hypertension, and decreased cardiac index. Independent determinants of reduced eGFR during follow-up were age, female gender, PAH etiology, systemic hypertension, decreased cardiac index, and increased right atrial pressure. Age ≥60 years, female gender, NYHA 4, and CKD at diagnosis were independently associated with decreased survival. The adjusted hazards ratio for death associated with CKD was 1.81 (95% confidence interval [1.01-3.25]). CONCLUSION: CKD is frequent at PAH diagnosis and is independently associated with increased mortality. Right heart failure may induce renal hypoperfusion and congestion, and is associated with eGFR decrease.
Authors: Edda Spiekerkoetter; Elena A Goncharova; Christophe Guignabert; Kurt Stenmark; Grazyna Kwapiszewska; Marlene Rabinovitch; Norbert Voelkel; Harm J Bogaard; Brian Graham; Soni S Pullamsetti; Wolfgang M Kuebler Journal: Pulm Circ Date: 2019-11-20 Impact factor: 3.017
Authors: Steffen D Kriechbaum; Lillith Scherwitz; Christoph B Wiedenroth; Felix Rudolph; Jan-Sebastian Wolter; Moritz Haas; Ulrich Fischer-Rasokat; Andreas Rolf; Christian W Hamm; Eckhard Mayer; Stefan Guth; Till Keller; Stavros V Konstantinides; Mareike Lankeit; Christoph Liebetrau Journal: ERJ Open Res Date: 2020-11-02
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Authors: Jiandong Zhou; Oscar Hou In Chou; Ka Hei Gabriel Wong; Sharen Lee; Keith Sai Kit Leung; Tong Liu; Bernard Man Yung Cheung; Ian Chi Kei Wong; Gary Tse; Qingpeng Zhang Journal: Front Cardiovasc Med Date: 2022-07-08