Li Zhilian, Liang Xinling, Liu Shuangxin, Ye Zhiming, Chen Yuanhan, Wang Wenjian, Li Ruizhao, Xu Lixia, Feng Zhonglin, Shi Wei
Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Southern Medical University, Guangzhou, China.
Southern Medical University, Guangzhou, China.
PLoS One. 2014 Dec 19;9(12):e114392. doi: 10.1371/journal.pone.0114392. eCollection 2014.
Pulmonary hypertension (PH) was recently recognized as a common complication of end-stage renal disease (ESRD) that causes an increased risk of mortality. Epidemiological data for this disorder in earlier stages of chronic kidney disease (CKD) and its association with cardiovascular (CV) morbidity are scarce.
We retrospectively analyzed 2,351 Chinese CKD patients with complete clinical records and echocardiography data between Jan 2008 and May 2012. The patients were divided into the following 6 groups: CKD Stages 1-4; Stage 5 for those not on or initiated on hemodialysis for <3 months; and Stage 5D for the patients undergoing hemodialysis for ≥3 months. The prevalence of PH and CV morbidity was investigated, and their association was evaluated with a logistic regression model.
PH was detected in 426 patients (18.1%). Mild, moderate and severe PH was diagnosed in 12.1%, 4.9% and 1.1% of the patients, respectively. Severe PH was detected in CKD Stages 5 and 5D. CV morbidity was found in 645 patients (27.4%). Compared with the non-PH group, the PH group had a higher risk for cardiac disease but not for cerebrovascular disease risk. PH severity was associated with cardiac morbidity risk [odds ratio (95% CI) for mild PH: 1.79 (1.30-2.47); moderate PH: 2.75 (1.73-4.37); severe PH: 3.90 (1.46-10.42)].
Our study showed for the first time the epidemiology profile of PH across the spectrum of CKD. Mild-to-moderate PH occurs with more frequency in advanced CKD, and severe PH is scarce in non-ESRD CKD. PH in CKD is associated with cardiac but not cerebrovascular disease, with increasing cardiac morbidity seen with increasing PH severity. Evidence from prospective studies addressing PH in this population is needed to predict cardiac events.
肺动脉高压（PH）最近被认为是终末期肾病（ESRD）的常见并发症，会导致死亡风险增加。关于慢性肾脏病（CKD）早期阶段该疾病的流行病学数据及其与心血管（CV）发病率的关联尚少。
我们回顾性分析了2008年1月至2012年5月期间2351例有完整临床记录和超声心动图数据的中国CKD患者。患者被分为以下6组：CKD 1 - 4期；未进行血液透析或开始血液透析<3个月的5期患者；以及接受血液透析≥3个月的5D期患者。调查了PH和CV发病率，并使用逻辑回归模型评估它们之间的关联。
426例患者（18.1%）检测到PH。轻度、中度和重度PH分别在12.1%、4.9%和1.1%的患者中被诊断出。重度PH在CKD 5期和5D期被检测到。645例患者（27.4%）发现有CV发病率。与非PH组相比，PH组患心脏病的风险更高，但患脑血管疾病的风险无差异。PH严重程度与心脏发病风险相关[轻度PH的比值比（95%置信区间）：1.79（1.30 - 2.47）；中度PH：2.75（1.73 - 4.37）；重度PH：3.90（1.46 - 10.42）]。
我们的研究首次展示了CKD全病程中PH的流行病学概况。中重度PH在晚期CKD中更常见，非ESRD的CKD中重度PH较少见。CKD中的PH与心脏病相关而非脑血管疾病，且随着PH严重程度增加心脏发病率上升。需要前瞻性研究的证据来预测该人群中的心脏事件。
