Yigla Mordechai, Fruchter Oren, Aharonson Doron, Yanay Noa, Reisner Shimon A, Lewin Moshe, Nakhoul Farid
Division of Pulmonary Medicine, Rambam Health Care Campus and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Haifa, Israel.
Kidney Int. 2009 May;75(9):969-75. doi: 10.1038/ki.2009.10. Epub 2009 Feb 11.
Pulmonary hypertension in patients with end-stage renal disease on hemodialysis is a newly described entity. To determine its impact, we measured selected clinical variables in the survival of 127 hemodialysis patients. Overall, pulmonary hypertension was found in 37 of these patients; it was already prevalent in 17 of them before initiation of dialysis and was associated with severe cardiac dysfunction. In the other 20 it developed after dialysis began, without obvious cause. These two subgroups of patients had similar survival curves, which were significantly worse in comparison to those without pulmonary hypertension. Following the initiation of hemodialysis, 20 patients with otherwise matched clinical variables survived significantly longer than the 20 who developed pulmonary hypertension after dialysis began. With univariate analysis, significant hazard ratios were found for age at onset of hemodialysis therapy (1.7), valvular diseases (1.8), pulmonary hypertension prevalence before hemodialysis (3.6) and incident after hemodialysis (2.4) for predicting mortality. In a multivariable Cox proportional hazard model, the development of pulmonary hypertension both before and after initiation of hemodialysis had significantly increased odds ratios and remained an independent predictor of mortality. Our study shows the incidence of pulmonary hypertension, after initiation of hemodialysis therapy, is a strong independent predictor of mortality nearly equal to that associated with long-standing severe cardiac abnormalities.
接受血液透析的终末期肾病患者的肺动脉高压是一种新描述的病症。为了确定其影响，我们在127例血液透析患者的生存过程中测量了选定的临床变量。总体而言，这些患者中有37例发现患有肺动脉高压；其中17例在开始透析之前就已普遍存在，并伴有严重的心功能不全。另外20例在透析开始后出现，无明显病因。这两组患者的生存曲线相似，与无肺动脉高压的患者相比明显更差。开始血液透析后，20例临床变量匹配的患者比20例透析开始后出现肺动脉高压的患者存活时间明显更长。单因素分析发现，血液透析治疗开始时的年龄（1.7）、瓣膜疾病（1.8）、透析前肺动脉高压患病率（3.6）和透析后发生率（2.4）对预测死亡率具有显著的风险比。在多变量Cox比例风险模型中，血液透析开始前和开始后肺动脉高压的发生均具有显著升高的比值比，并且仍然是死亡率的独立预测因素。我们的研究表明，血液透析治疗开始后肺动脉高压的发生率是死亡率的一个强大独立预测因素，几乎与长期严重心脏异常相关的因素相当。
