Analysis Of Risk Factors For Pulmonary Hypertension In Patients With Chronic Kidney Disease

Objective: To explore the risk factors for pulmonary hypertension(PH)in patients with chronic kidney disease(CKD)3-5D phase,so as to facilitate prevention and treatment of PH in CKD patients.Methods: We enrolled 436 patients with CKD3-5D during the period from January 2015 to July 2017.Age,gender,primary diseases,laboratorial and echocardiography findings were collectived and compared in all patients.Pulmonary artery systolic pressure(PASP)were tested by Doppler echocardiography in 436 patients.According to the results of Doppler echocardiography examination,the patients were divided into PH group(PASP ?35 mm Hg)and non-pulmonary hypertension(N-PH)group(PASP <35 mm Hg).Hemodialysis patients were divied into PH group(85 cases)and N-PH group(51cases).Peritoneal dialysis patients were divied into PH group(24 cases)and N-PH group(41 cases).Non dialysis patients were divied into PH group(99 cases)and N-PH group(136 cases).Fifty healthy volunteers were enrolled in the study as normal group.Univariate analysis and binary logistic regression analysis were used to analyse the independent risk factors for PH in patients with chronic kidney disease.Results: 1.Age,left atrial diameter(LAD),right ventricle diameter(RVD),left ventricular posterior wall diameter(LVPWD),left ventricular end diasrolic diameter(LVDd),left ventricular end systolic dimension(LVDs),main pulmonary artery diameter(MPAD),the level of plasma parathyroid hormone(PTH),the level of C-reactive protein(CRP)were significantly higher in PH group than that in N-PH group of 436 patients(P<0.05).The level of hemoglobin(Hb),blood calcium,blood uric acid(BUA)and left ventricular ejection fraction(LVEF)were significantly lower in PH group than that in N-PH group of 436 patients(P<0.05).The Logistic regression analysis showed that advanced-age(OR=1.021,P=0.016),the high level of plasma PTH(OR=1.001,P=0.041),the decreasing of LVEF(OR=0.896,P=0.026),the high level of CRP(OR=1.091,P=0.032)were independent risk factors for PH in patients with CKD.2.The level of Hb,serum creatinine(SCr)and magnesium were significantly lower in the PH group than that in N-PH of MHD sub-group.LAD,AAOD,MPAD and frequency of pulmonary infection were significantly higher and more in the PH-group than that in N-PH of MHD sub-group(P<0.05).The Logistic regression analysis showed that the high level of CRP(OR=1.466,P=0.028),the increasing of LAD(OR=1.136,P=0.020)and anemia(OR=0.967,P=0.041)were the risk factors of PH in MHD patients.3.The level of Hb,plasma albumin(Alb)and LVEF were significantly lower in the PH group than that in N-PH of PD sub-group.Plasma PTH was significantly higher in the PH group than that in N-PH of PD sub-group(P<0.05).The Logistic regression analysis showed that the low level of Alb(OR=0.783,P=0.032)was the risk factor of PH in PD patients.4.There was a positive correlation between PASP and glomerular filtration rate(e GFR)(OR=0.202,P=0.002)in the non-dialysis subgroup.There was a positive correlation between the level of fibrinogen and e GFR(OR=-0.167,P=0.044)in the non-dialysis subgroup.There was a positive correlation between platelet count and e GFR(OR=0.221,P=0.001).There was a negative correlation between the level of CRP and the level of Alb(OR=-0.194,P=0.003)in the non-dialysis subgroup.There was a negative correlation between the level of CRP and LVEF(OR=-0.165,P=0.012)in the non-dialysis subgroup.Conclusions: Advanced-age,the high level of PTH,CRP and the decreasing of LVEF may be independent risk factors for PH in patients with CKD3-5D phase.The high level of CRP,the increasing of LAD and anemia may be independent risk factors for PH in patients with MHD.The low level of Alb may be an independent risk factor for PH in patients with PD.Effective dialysis,inflammation control,improvement of cardiac function,nutritional support and improvement of anemia are beneficial for the prevention and treatment of PH in CKD patients.