Pulmonary hypertension is prevalent in catheter and arterio-venous access hemodialysis
Pulmonary hypertension (PH) has been described in patients undergoing hemodialysis and proposed to arise from overflow in arterio-venous grafts or fistulae. Whether PH is prevalent in patients undergoing catheter-based dialysis is unknown. Patients undergoing hemodialysis with an echocardiogram in two urban dialysis centers over a four-year period were included. Demographic data, comorbidities, dialysis access, laboratory and echocardiographic data were collected. A right ventricular systolic pressure of ≥45 mmHg defined PH. Forty out of ninety-one (44%) patients met the criteria for PH. The prevalence of catheter-based hemodialysis was similar in the two groups (30% in the PH vs. 33% in the no-PH group). PH patients were more likely to have extended hemodialysis vintage (52.6±58.2 vs. 31.0±33.7 months, P less than 0.05). Advanced left heart disease was not more prevalent in patients with PH although they were more likely to have right atrial and right ventricular enlargement (P less than 0.05). Mean serum phosphate was lower in the PH group (4.7±1.4 vs. 5.5±1.8 mg/dL, P less than 0.05). On multivariate analysis, lower phosphate levels were associated with higher risk of PH. We concluded that PH is prevalent in hemodialysis regardless of access type and may be because of disordered calcium and phosphate metabolism.
Submitted: 2009-10-03 03:01:16
Published: 2010-02-11 08:12:24
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