Pulmonary Hypertension Subtypes and Mortality in CKD
| Autor: | Sudarshan Rajagopal, Myles Wolf, Linda K. Shaw, Dennis M. Abraham, Matthew A. Sparks, Kishan S. Parikh, Daniel L. Edmonston, Alexander Grabner |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Hypertension Pulmonary Population 030232 urology & nephrology Renal function Comorbidity Kaplan-Meier Estimate urologic and male genital diseases 03 medical and health sciences 0302 clinical medicine Cause of Death Internal medicine Prevalence medicine Humans 030212 general & internal medicine Mortality Renal Insufficiency Chronic education Aged Proportional Hazards Models Retrospective Studies education.field_of_study business.industry Hemodynamics Retrospective cohort study Middle Aged medicine.disease Pulmonary hypertension female genital diseases and pregnancy complications Diagnostic catheterization Nephrology Heart failure Cohort Female business Kidney disease |
| Zdroj: | American Journal of Kidney Diseases. 75:713-724 |
| ISSN: | 0272-6386 |
| DOI: | 10.1053/j.ajkd.2019.08.027 |
| Popis: | Rationale & Objective Pulmonary hypertension (PH) contributes to cardiovascular disease and mortality in patients with chronic kidney disease (CKD), but the pathophysiology is mostly unknown. This study sought to estimate the prevalence and consequences of PH subtypes in the setting of CKD. Study Design Observational retrospective cohort study. Setting & Participants We examined 12,618 patients with a right heart catheterization in the Duke Databank for Cardiovascular Disease from January 1, 2000, to December 31, 2014. Exposures Baseline kidney function stratified by CKD glomerular filtration rate category and PH subtype. Outcomes All-cause mortality. Analytical Approach Multivariable Cox proportional hazards analysis. Results In this cohort, 73.4% of patients with CKD had PH, compared with 56.9% of patients without CKD. Isolated postcapillary PH (39.0%) and combined pre- and postcapillary PH (38.3%) were the most common PH subtypes in CKD. Conversely, precapillary PH was the most common subtype in the non-CKD cohort (35.9%). The relationships between mean pulmonary artery pressure, pulmonary capillary wedge pressure, and right atrial pressure with mortality were similar in both the CKD and non-CKD cohorts. Compared with those without PH, precapillary PH conferred the highest mortality risk among patients without CKD (HR, 2.27; 95% CI, 2.00-2.57). By contrast, in those with CKD, combined pre- and postcapillary PH was associated with the highest risk for mortality in CKD in adjusted analyses (compared with no PH, HRs of 1.89 [95% CI, 1.57-2.28], 1.87 [95% CI, 1.52-2.31], 2.13 [95% CI, 1.52-2.97], and 1.63 [95% CI, 1.12-2.36] for glomerular filtration rate categories G3a, G3b, G4, and G5/G5D). Limitations The cohort referred for right heart catheterization may not be generalizable to the general population. Serum creatinine data in the 6 months preceding catheterization may not reflect true baseline CKD. Observational design precludes assumptions of causality. Conclusions In patients with CKD referred for right heart catheterization, PH is common and associated with poor survival. Combined pre- and postcapillary PH was common and portended the worst survival for patients with CKD |
| Databáze: | OpenAIRE |
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