Kidney Res Clin Pract.
2025 Jan;44(1):145-154. 10.23876/j.krcp.23.021.
Clinical influencing factors affecting pulmonary hypertension in hemodialysis patients
- Zhang X
1,2,3 - Xiao K1,2,3
- Li L1,2,3
- Wang N1,2,3
- Cong T4
- Wei Y5
- Cao S6
- Wen X1,2,3
- Meng Q1,2,3
- Lin H1,2,3
- Wu T1,7
- Affiliations
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- 1Graduate School of Dalian Medical University, Dalian, China
- 2Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, Liaoning Province Translational Medicine Research Center of Kidney Disease, Dalian, China
- 3Kidney Research Institute of Dalian Medical University, Dalian, China
- 4Department of Cardiac Echocardiography, The First Affiliated Hospital of DaLian Medical University, Dalian, China
- 5Department of Scientific Research, The First Affiliated Hospital of DaLian Medical University, Dalian, China
- 6Department of Clinical Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- 7Department of Respiratory, The First Affiliated Hospital of DaLian Medical University, Dalian, China
- KMID: 2572810
- DOI: http://doi.org/10.23876/j.krcp.23.021
Abstract
- Background
The fluid status and rate of blood flow through the arteriovenous fistula (AVF) are two important factors affecting hemodynamic in hemodialysis patients; however, their effects on pulmonary hypertension have rarely been studied. Hence, we aimed to evaluate the effects of these factors in hemodialysis patients with pulmonary hypertension. Methods: This single-center cross-sectional survey included 219 maintenance hemodialysis patients (139 [63.5%] male). The prevalence of pulmonary hypertension was 13.6% (30 of 219). Pulmonary artery pressure was measured by echocardiography, fluid status was measured objectively using bioimpedance spectroscopy, and blood flow rate in the AVF (Qa) was determined using Doppler ultrasound. Results: The overall mean overhydration before hemodialysis was 1.5 L (range, 0.6–2.8 L). The mean overhydration in patients with and without pulmonary hypertension was 3.6 L (range, 2.3–4.6 L) and 1.4 L (range, 0.6–2.4 L), respectively (p < 0.001). The overall mean Qa was 780 mL/min (range, 570–1,015.5 mL/min). The mean Qa of patients with and without pulmonary hypertension was 672 mL/min (range, 505.7–982.2 mL/min) and 790 mL/min (range, 591–1,026 mL/min), respectively (p = 0.27). Overhydration (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.08–1.97; p = 0.01), N-terminal prohormone of brain natriuretic peptide (NT-proBNP; OR, 1.36; 95% CI, 1.09–1.71; p = 0.007), and left atrial diameter (OR, 1.14; 95% CI, 1.01–1.28; p = 0.03) were risk factors. Conclusion: Pulmonary hypertension is strongly associated with overhydration, NT-proBNP, and left atrial diameter in hemodialysis patients
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