Risk Factors Of Pulmonary Hypertension In Peritoneal Dialysis Patients

Objective: To explore the occurrence and the risk factors of pulmonary hypertension(PH)in continuous ambulatory peritoneal dialysis(CAPD)patients.Methods: Patients with continuous ambulatory peritoneal dialysis who were followed up regularly in the Department of Nephrology,the First Affiliated Hospital of Guangxi Medical University were enrolled.Data were collected from patients who returned to hospital from January 1,2017 to December 31,2018 and finished the echocardiography examination at the same time.Pulmonary artery systolic pressure(PASP)derived from tricuspid regurgitation by echocardigraphy.PASP >35 mmHg was diagnosed as PH at rest.According to the PH of the case,the patients were divided into PH group and non-pulmonary hypertension(NPH)group.The differences of clinical data between these two groups were compared.The multivariate logistic regression model was used to analyze the risk factors of PH in CAPD patients.Finally,the ROC curve was used to evaluate the predictive value of independent risk factors for PH risk in CAPD patients.Results: Of the 131 patients,72 were male and 59 were female,with a male to female ratio of 1.22:1.The mean age was 47.2 ± 11.5 years and the meanperitoneal dialysis age was 16.0(8.0,33.0)months.The occurrence of PH in CAPD patients was 26.0%(34/131).Compared to the NPH group,patients in the PH group had higher levels of left atrial diameter,left ventricular end-diastolic diameter,left ventricular end-sectional diameter,interventricular septal thickness,left ventricular posterior wall thickness,right ventricular diameter,right ventricular outflow tract,main pulmonary artery diameter,LVMI,systolic blood pressure and the occurrence of left atrial enlargement,and lower left ventricular ejection fraction,serum albumin,serum 25(OH)D3 and blood pressure control ratet(P<0.05).Multivariate logistic regression model suggested that left atrial enlargement(OR=8.935,95%CI: 3.04—26.262,P<0.001),higher systolic blood pressure(OR=1.029,95%CI: 1.007—1.051,P=0.01)and lower blood albumin(OR=0.895,95%CI: 0.811—0.988,P=0.028)were independent risk factors for pulmonary hypertension in CAPD patients.ROC curve showed the area under the curve that systolic blood pressure predict the occurrence of PH was 0.718,and the best cut off point of systolic blood pressure was145.5mmHg(sensitivity 76.5%,specificity 59.1%).Multivariate logistic regression analysis showed that the risk of PH was 3.854 times in CAPD patients with systolic blood pressure >145.5mmHg compared to the CAPD patients with systolic blood pressure ? 145.5 mmHg.Conclusion: PH was relatively prevalent in CAPD patients.Left atrial enlargement,higher systolic blood pressure and lower blood albumin were independent risk factors for PH in CAPD patients.The control level of systolic blood pressure may be used as predictors of PH in CAPD patients.