开始腹膜透析患者的肺动脉高压。

Pulmonary Hypertension in Patients Starting Peritoneal Dialysis.

机构信息

Servicio de Cardiología, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XX, Instituto Mexicano del Seguro Social, Ciudad de México, México.

Unidad de Investigación en Enfermedades Nefrologicas, Unidad Medica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.

出版信息

Arch Med Res. 2020 Apr;51(3):254-260. doi: 10.1016/j.arcmed.2020.02.004. Epub 2020 Feb 26.

DOI:10.1016/j.arcmed.2020.02.004

PMID:32111492

Abstract

BACKGROUND

Cardiovascular complications are the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). One such complication is pulmonary hypertension (PH). Its prevalence in patients in peritoneal dialysis (PD) varies from 12.6-41.7% and its related factors are not well known. The main objective of this multicenter study was to determine the prevalence of PH and its risk factors in patients starting in PD.

METHODS

Patients incident in PD were studied. Clinical, biochemical, and PD parameters were evaluated. A transthoracic echocardiography was performed and the evaluated according to the American Society of Echocardiography. Systolic pulmonary artery pressure (sPAP) was calculated with tricuspid regurgitation gradient and PH considered if pulmonary artery pressure was ≥35 mmHg.

RESULTS

There were 105 men and 72 women included in the study (aged 53.7 ± 12.8 vs. 52.9 ± 15.5 years). PH was found in 69 patients (38.98%), they had sPAP of 49.05 ± 13.80 vs. 18.81 ± 11.15 mmg, in patients without PH (p <0.001). Patients with PH tend to be more frequently men than women (42 vs. 35%, p = 0.33), and were younger (51.0 ± 14.9 vs. 55,1 ± 12.8 years; p = 0.05). Risk factor for PH were diastolic dysfunction of the left ventricle (LV) (OR = 1.46, 95% CI 1.094-1.973), left ventricular hypertrophy (LVF) (OR = 2.56, 95% CI 1.29-5.09); and residual renal function (RRF) was a protector factor (OR = 0.78, 95% CI 0.068-0.915).

CONCLUSIONS

Prevalence of PH in patient's incident in PD was 38%. The factors associated with PH were diastolic dysfunction of the LV and LV hypertrophy. RRF was a protector factor.

摘要

背景

心血管并发症是慢性肾脏病（CKD）患者发病率和死亡率的主要原因。其中一种并发症是肺动脉高压（PH）。在腹膜透析（PD）患者中，其患病率为 12.6-41.7%，其相关因素尚不清楚。本多中心研究的主要目的是确定开始 PD 治疗的患者中 PH 的患病率及其危险因素。

方法

研究了新开始 PD 治疗的患者。评估了临床、生化和 PD 参数。进行了经胸超声心动图检查，并根据美国超声心动图学会进行评估。通过三尖瓣反流梯度计算收缩期肺动脉压（sPAP），如果肺动脉压≥35mmHg，则认为存在 PH。

结果

研究纳入了 105 名男性和 72 名女性（年龄 53.7±12.8 岁 vs. 52.9±15.5 岁）。69 名患者（38.98%）存在 PH，其 sPAP 为 49.05±13.80mmHg，而无 PH 的患者为 18.81±11.15mmHg（p<0.001）。与女性相比，PH 患者更常为男性（42%比 35%，p=0.33），且年龄更小（51.0±14.9 岁比 55.1±12.8 岁；p=0.05）。PH 的危险因素包括左心室（LV）舒张功能障碍（OR=1.46，95%CI 1.094-1.973）、左心室肥厚（LVF）（OR=2.56，95%CI 1.29-5.09）；残余肾功能（RRF）是保护因素（OR=0.78，95%CI 0.068-0.915）。