Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-study

Stefan Pabst, Christoph Hammerstingl, Felix Hundt, Thomas Gerhardt, Christian Grohé, Georg Nickenig, Rainer Woitas, Dirk Skowasch, Stefan Pabst, Christoph Hammerstingl, Felix Hundt, Thomas Gerhardt, Christian Grohé, Georg Nickenig, Rainer Woitas, Dirk Skowasch

Abstract

Pulmonary hypertension (PH) is common in patients with dialysis-dependent chronic kidney disease and is an independent predictor of mortality. However, specific hemodynamics of the pulmonary circulation, changes induced by hemodialysis and characterization into pre- or postcapillary PH have not been evaluated in patients with chronic kidney disease. We assessed consecutive patients with end-stage chronic kidney disease in WHO FC ≥ II with dyspnea unexplained by other causes on hemodialysis (group 1, n = 31) or without dialysis (group 2, n = 31) using right heart catheterization (RHC). In group 1, RHC was performed before and after dialysis. In end-stage chronic kidney disease, prevalence of precapillary PH was 13% (4/31), and postcapillary PH was discovered in 65% (20/31). All four cases of precapillary PH were unmasked after dialysis. In group 2, two cases of precapillary PH were detected (6%), and postcapillary PH was diagnosed in 22 cases (71%). This is the first study examining a large cohort of patients with chronic kidney disease invasively by RHC for the prevalence of PH. The prevalence of precapillary PH was 13% in patients with end-stage kidney disease. That suggests careful screening for precapillary PH in this selected patient population. RHC should be performed after hemodialysis.

Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: SP, CH, and DS received remuneration for lecturing and grants for travel expenses from Actelion Pharmaceuticals and GlaxoSmithKline. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1. Enrolment of Patients.
Figure 1. Enrolment of Patients.
CKD: chronic kidney disease; Pulmonary hypertension (PH): mean pulmonary arterial pressure (mPAP) ≥25 mmHg; *postcapillary PH: mPAP ≥25 mmHg and pulmonary capillary wedge pressure (PCWP) ≥15 mmHg; #precapillary PH: mPAP ≥25 mmHg and PCWP

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