DOI: N/A
Islam MS, Islam MR, Mazumder RC, Saha S, Nurunnabi M
Background: Pulmonary hypertension (PH) is a significant cardiovascular complication of chronic kidney disease (CKD), associated with increased morbidity and mortality, but its prevalence, predictors, and outcomes remain underexplored in developing countries.
Objective: To assess the prevalence, severity, and predictors of PH in CKD patients and evaluate its impact on clinical outcomes over 12 months.
Methods: This observational cross-sectional study with prospective follow-up was conducted at Sylhet Women’s Medical College Hospital from January 2023 to December 2024. A total of 200 CKD patients (stages III–V) were enrolled. Transthoracic echocardiography was used to diagnose PH (PASP ≥35 mmHg) and assess severity. Demographic, clinical, laboratory, cardiovascular, and dialysis-related data were collected. Patients were followed for 12 months to evaluate cardiovascular hospitalizations, all-cause mortality, and dialysis-related complications.
Result: PH was present in 41% of patients, with prevalence increasing with CKD stage (Stage III: 25.7%, Stage IV: 41.7%, Stage V: 55.7%, p<0.001). Dialysis dependency in stage V CKD was strongly associated with PH (76.0% vs. 30.0% in non-dialysis patients, p<0.001). PH was mild in 42.5%, moderate in 46.3%, and severe in 11.2% of affected patients. Independent predictors of PH included LV diastolic dysfunction (OR: 3.8, 95% CI: 2.0–7.2), hemoglobin <10 g/dL (OR: 2.6, 95% CI: 1.4–5.0), age >55 years (OR: 2.2, 95% CI: 1.2–4.1), AV fistula presence (OR: 2.3, 95% CI: 1.2–4.5), and poorly controlled hypertension (OR: 2.0, 95% CI: 1.1–3.6). At 12 months, cardiovascular hospitalizations (36.3% vs. 14.2%, p<0.01) and all-cause mortality (16.3% vs. 5.0%, p=0.03) were higher in patients with PH. Dialysis-related complications were more frequent but not statistically significant.
Conclusion: PH is prevalent in CKD, particularly in advanced stages and dialysis-dependent patients, and is associated with worse cardiovascular outcomes. LV diastolic dysfunction, anemia, older age, AV fistula, and uncontrolled hypertension are significant predictors.