Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, NC., Chapel Hill, NC.
Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Transplantation. 2020 Oct;104(10):2113-2119. doi: 10.1097/TP.0000000000003068.
Pulmonary hypertension (PH) is frequently reported in patients with advanced chronic kidney disease and is associated with early allograft failure and death. However, the causes of PH are heterogeneous, and patient prognosis may vary by etiologic subtype.
Data from the University of North Carolina Cardiorenal Registry were examined to determine associations between PH, with or without elevated left atrial pressure (eLAP), and mortality in candidates for kidney transplantation. PH and eLAP were determined by Doppler echocardiography and by tissue Doppler imaging, respectively.
From 2006 to 2013, 778 registry patients were screened preoperatively by echocardiography. Most patients were black (64%) and men (56%); the mean age was 56 years. PH was identified in 97 (12%) patients; of these, eLAP was prevalent in half. During a median follow-up of 4.4 years, 179 (23%) received a kidney transplant, and 195 (25%) died. After adjustments for demographics, comorbidities, dialysis vintage, and kidney transplantation, PH was associated with twice the 5-year mortality (hazard ratio [HR] = 2.11; 95% confidence interval [CI]: 1.48-3.03), with stronger associations in the absence of eLAP (HR = 2.87; 95% CI: 1.83-4.49) than with eLAP (HR = 1.11; 95% CI: 0.57-2.17), P for interaction = 0.01.
The mortality risk associated with PH among patients with advanced chronic kidney disease appears to differ by etiology. Patients with PH in the absence of eLAP are at high risk of death and in need of focused attention. Future research efforts should investigate potential strategies to improve outcomes for these patients.
肺动脉高压（PH）在晚期慢性肾脏病患者中经常被报道，并与早期移植物失败和死亡相关。然而，PH 的病因具有异质性，且患者的预后可能因病因亚型而异。
研究人员分析了北卡罗来纳大学心脏肾脏登记处的数据，以确定接受肾移植候选者中存在或不存在左心房压升高（eLAP）的 PH 与死亡率之间的关系。PH 和 eLAP 分别通过多普勒超声心动图和组织多普勒成像来确定。
2006 年至 2013 年，778 名登记患者接受了术前超声心动图筛查。大多数患者为黑人（64%）和男性（56%）；平均年龄为 56 岁。778 名患者中有 97 名（12%）被诊断为 PH，其中半数存在 eLAP。在中位随访 4.4 年期间，179 名（23%）接受了肾移植，195 名（25%）死亡。经过调整人口统计学、合并症、透析龄和肾移植后，PH 与 5 年死亡率增加两倍相关（风险比 [HR] = 2.11；95%置信区间 [CI]：1.48-3.03），在没有 eLAP 的情况下相关性更强（HR = 2.87；95% CI：1.83-4.49），而存在 eLAP 时的相关性较弱（HR = 1.11；95% CI：0.57-2.17），P 交互= 0.01。
晚期慢性肾脏病患者中 PH 相关的死亡率似乎因病因而异。不存在 eLAP 的 PH 患者死亡风险高，需要重点关注。未来的研究工作应探讨改善这些患者结局的潜在策略。
