Risk Factors For Pulmonary Artery Hypertension In Patients And Elderly Patients Undergoing Maintenance Peritoneal Dialysis

Objective: This study investigated the risk factors associated with pulmonary arteryhypertension (PAH) in common patients and elderly patients with end-stage renal disease(ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD).Methods:1. A total of31patients with PAH (PAH group) and31patients withoutPAH (non-PAH group) who underwent CAPD for18months at our hospital were includedin this study. All patients were roughly matched for age, gender, and duration of dialysis.Measurements of hemoglobin, creatinine, urea nitrogen, parathyroid hormone (iPTH), leftatrial diameter, left ventricular systolic diameter, ejection fraction, early peak flow velocity(E), atrium peak flow velocity (A), E/A, pericardial effusion, mitral valve calcification, andleft ventricular mass index (LVMI) were recorded in detail.2. A retrospective review of143CAPD patients at least for18months with completemedical records in our hospital from Jan2007to Sep2013to analysis the pulmonaryhypertention related factors. Including hemoglobin, creatinine, urea nitrogen, parathyroidhormone (iPTH), left atrial diameter, left ventricular systolic diameter, ejection fraction,early peak flow velocity (E), atrium peak flow velocity (A), E/A, mitral valve calcification,and left ventricular mass index (LVMI) were recorded in detail. Patients over60years forthe elderly group,the others for the control group.3. Statistical analysis was performed using SPSS for windows, version17.0(SPSS Inc,Chicago, IL, USA), and P <0.05was considered statistical significance.Results:1. Compared to the non-PAH group, patients in the PAH group showedsignificant differences in hemoglobin (88.74±22.21vs.99±17.52g/L, P=0.032), left atrialdiameter (46.81±5.57vs.41.86±6.06mm, P=0.002), FS (29.89±6.17vs.32.85±5.03%, P=0.045), E (1.06±0.38vs.0.72±0.26m/s, P <0.001), serum iron [7.1(5.1,11.25) vs.8.8(6.8,13.5) mmol/L, P=0.03], EF [56.4(53.34,63.22) vs.60.4(56.32,66.83)%, P=0.028],septal thickness [12(10.5,14) vs.11(10,12) mm, P=0.018], left ventricular wall thickness[11.2(10,13) vs.10(9.1,11.9) mm, P=0.011], AVO flow [1.46(1.29,1.65) vs.1.24(1.1,1.36), P=0.002], E/A [1.02(0.82,1.52) vs.0.68(0.58,0.82) cm/s, P=0.00], Vs [8(7.7,10)vs9(8,11) m/s, P=0.043], LVMI [141.7(116.29,182.32) vs.117(97.01,133.12) g/m2,P=0.002],4-h glucose transport rate [0.46(0.38,0.5) vs.0.5(0.42,0.54), P=0.042],pericardial effusion (P=0.019), and mitral valve calcification (P=0.016). Univariateregression analysis showed that PAH was negatively correlated with hemoglobin(B=-0.029, P=0.04) and EF (B=-0.072, P=0.04) but was positively correlated with leftatrial diameter (B=0.152, P=0.004), ventricular septal thickness (B=0.302, P=0.025), leftventricular wall thickness (B=0.397, P=0.012), E (B=3.234, P=0.001), E/A (B=2.428,P=0.004), LVMI (B=0.024, P=0.004), mitral valve calcification (B=1.636, P=0.022), andpericardial effusion (B=1.297, P=0.021). Multivariate regression analysis showed that4-hglucose transport (OR=24.77, P=0.038), LVMI (OR=1.035, P=0.03), and mitral valvecalcification (OR=10.313, P=0.023) were independently corrected with PAH.2.32patients of total patients complicated with pulmonary hypertention, theincidence is22.4%, the incidence in the elder group is21%(13/62), and the control group23.5%(19/81), there is no statistical significance between the two group.In the elder group,Compared to the non-PAH group, patients with PAH group showed significant differencesin dialysis age, left atrial diameter, left ventricular diastolic diameter, left ventricularsystolic diameter,ejection fraction, early peak flow velocity (E), E/A, LVMI, mitral valvecalcification (P <0.05). Hemoglobin, HCT, UA，Alb, Ferritin, left atrial diameter, septalthickness, left ventricular wall thickness, LVEF, E, E/A, Vs, LVMI is significant difference(P <0.05) in the control group between with PAH and with non-PAH. Univariateregression analysis showed that,in the elder group,PAH was negatively correlated withLVEF (B=-0.083, P=0.03) but was positively correlated with dialysis age (B=0.058,P=0.007), left atrial diameter (B=0.205, P=0.002), left ventricular diastolic diameter (B=0.112, P=0.037), left ventricular wall thickness (B=0.3386, P=0.037), E (B=3.729,P=0.002), E/A (B=3.413, P=0.001), LVM (B=0.01, P=0.022), LVMI (B=0.007, P=0.012).In the control group, PAH was negatively correlated with Hb (B=-0.036, P=0.005), HCT(B=-0.102, P=0.014), Alb (B=-0.114, P=0.03), LVEF (B=-0.069, P=0.0026) but waspositively correlated with left atrial diameter (B=0.153, P=0.002), left ventricular systolicdiameter (B=0.103, P=0.013), septal thickness (B=0.304, P=0.01), left ventricular wallthickness (B=0.348, P=0.007), E (B=3.93, P=0.001), E/A (B=2.626, P=0.004), LVMI(B=0.011, P=0.002), aortic valve calcification E (P=0.049), mitral valve calcification(P=0.038). Multivariate regression analysis showed that left atrial diameter (OR=1.306,P=0.014), E/A (OR=4.95, P=0.009), and dialysis age (OR=1.116, P=0.11) wereindependently corrected with CAPD PAH in the elder group and Hb (OR=0.8, P=0.01),HCT (OR=1.99, P=0.018), left atrial diameter (B=1.16, P=0.005). E/A (OR=2.16, P=0.019)were independently corrected with CAPD PAH in the elder group.Conclusion:1. For CAPD patients, anemia and a reduction in left ventricular systolicfunction may increase the incidence of PAH. Moreover, our results indicate that4-hglucose transport rate, LVMI, and mitral valve calcification represent independent riskfactors for PAH, although the precise mechanism requires further study.2. Elderly CAPD patients with pulmonary hypertention are common, left atrialdiameter, E/A and dialysis age are significantly correlated with the elderly CAPD patientswith pulmonary hypertention.