Noah C Schoenberg1, Rahul G Argula2, Elizabeth S Klings3, Kevin C Wilson3,4, Harrison W Farber5. 1. Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, 02215, MA, USA. nschoenb@bidmc.harvard.edu. 2. Pulmonary, Critical Care, Allergy & Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA. 3. The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA. 4. American Thoracic Society, New York, NY, USA. 5. Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Boston, MA, USA.
Abstract
INTRODUCTION: Pulmonary hypertension (PH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PH among patients with ESRD and compared mortality between ESRD patients with and without PH. METHODS: Two independent reviewers searched three databases using a search strategy built around the medical subject headings of "hypertension, pulmonary" and "kidney failure, chronic." Keywords and synonyms were also used. Study selection criteria included (1) Enrollment of patients with ESRD undergoing hemodialysis or peritoneal dialysis, (2) Assessment for the presence of PH using transthoracic echocardiography, and (3) Determination of PH prevalence or associated mortality. The primary outcomes were prevalence of PH or associated mortality. The Grading, Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence. RESULTS: The initial search identified 1046 publications, from which 41 studies were selected. The median prevalence of PH identified by echocardiographic criteria among patients with ESRD was 38% (range 8% to 70%), and was significantly increased in patients undergoing hemodialysis (HD) (median 40%, range 16-70%) as compared with peritoneal dialysis (PD) (median 19%, range 8-37%). Meta-analysis demonstrated that overall mortality was higher among ESRD patients with echocardiographic evidence of PH than ESRD patients without echocardiographic evidence of PH (RR 2.02; 95% CI 1.70-2.40). CONCLUSIONS: Echocardiographic evidence of PH is common among ESRD patients undergoing dialysis and associated with increased mortality. Identification of those patients with evidence of pulmonary hypertension on transthoracic echocardiography may warrant further evaluation and treatment.
INTRODUCTION:Pulmonary hypertension (PH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PH among patients with ESRD and compared mortality between ESRDpatients with and without PH. METHODS: Two independent reviewers searched three databases using a search strategy built around the medical subject headings of "hypertension, pulmonary" and "kidney failure, chronic." Keywords and synonyms were also used. Study selection criteria included (1) Enrollment of patients with ESRD undergoing hemodialysis or peritoneal dialysis, (2) Assessment for the presence of PH using transthoracic echocardiography, and (3) Determination of PH prevalence or associated mortality. The primary outcomes were prevalence of PH or associated mortality. The Grading, Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence. RESULTS: The initial search identified 1046 publications, from which 41 studies were selected. The median prevalence of PH identified by echocardiographic criteria among patients with ESRD was 38% (range 8% to 70%), and was significantly increased in patients undergoing hemodialysis (HD) (median 40%, range 16-70%) as compared with peritoneal dialysis (PD) (median 19%, range 8-37%). Meta-analysis demonstrated that overall mortality was higher among ESRDpatients with echocardiographic evidence of PH than ESRDpatients without echocardiographic evidence of PH (RR 2.02; 95% CI 1.70-2.40). CONCLUSIONS: Echocardiographic evidence of PH is common among ESRDpatients undergoing dialysis and associated with increased mortality. Identification of those patients with evidence of pulmonary hypertension on transthoracic echocardiography may warrant further evaluation and treatment.
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: Lucia Del Vecchio; Robert Ekart; Charles J Ferro; Jolanta Malyszko; Patrick B Mark; Alberto Ortiz; Pantelis Sarafidis; Jose M Valdivielso; Francesca Mallamaci Journal: Clin Kidney J Date: 2020-11-26