Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Cardiology Unit, University Hospital of Kinshasa, BP: 123, Kinshasa, XI, Democratic Republic of the Congo.
BMC Nephrol. 2020 Nov 4;21(1):460. doi: 10.1186/s12882-020-02131-x.
Although cardiovascular diseases in particular Pulmonary Arterial Hypertension (PAH) is associated with, high morbid-mortality in chronic hemodialysis, but its magnitude remains paradoxically unknown in sub-Saharan Africa. The aim of this study was to evaluate the prevalence of PAH and associated factors in chronic hemodialysis in Sub-Saharan African population.
In a cross-sectional study, patients treated with HD for at least 6 months in 4 hemodialysis centers were examined. PAH was defined as estimated systolic pulmonary arterial pressure (sPAP) ≥ 35 mmHg using transthoracic Doppler echocardiography performed 24 h after the HD session.
Eighty-five HD patients were included; their average age was 52.6 ± 15.9 years. Fifty-seven patients (67.1%) were male. Mean duration of HD was 13.3 ± 11 months. With reference to vascular access, 12 (14.1%), 29 (34.1%) and 44 (51.8%) patients had AVF, tunneled cuff and temporary catheter, respectively. The underlying cause of ESRD was diabetes in 30 patients (35.3%). The prevalence of PAH was 29.4%. Patients with PAH had more hyponatremia (11 (44%) vs 10 (16.7%), p = 0.010). In multivariate analysis, unsecured healthcare funding (aOR 4, 95% CI [1.18-6.018]), arrhythmia (aOR 3, 95% CI [1.29-7.34]), vascular access change (aOR 4, 95% CI [1.18-7.51]) and diastolic dysfunction (aOR 5, 95% CI [1.35-9.57] were independently associated with PAH.
One third of hemodialysis patients exhibit PAH, which is independently associated with low socioeconomic status (unsecured funding, vascular access change) and cardiovascular complications (arrhythmia, diastolic dysfunction).
尽管心血管疾病，尤其是肺动脉高压（PAH）与慢性血液透析患者的高病死率相关，但在撒哈拉以南非洲地区，其严重程度却令人费解。本研究旨在评估撒哈拉以南非洲地区慢性血液透析患者中 PAH 的患病率及相关因素。
这是一项横断面研究，共纳入了 4 家血液透析中心的至少接受了 6 个月血液透析治疗的患者。使用经胸多普勒超声心动图在血液透析结束后 24 小时测量估计的收缩期肺动脉压（sPAP），sPAP≥35mmHg 定义为 PAH。
共纳入 85 例血液透析患者，其平均年龄为 52.6±15.9 岁，57 例（67.1%）为男性，血液透析时间平均为 13.3±11 个月。血管通路方面，分别有 12 例（14.1%）、29 例（34.1%）和 44 例（51.8%）患者采用了动静脉内瘘、带隧道的袖套导管和临时导管。导致 ESRD 的基础病因中，糖尿病 30 例（35.3%）。PAH 的患病率为 29.4%。PAH 患者更易出现低钠血症（11 例[44%]比 10 例[16.7%]，p=0.010）。多变量分析显示，无保障的医疗保健资金（优势比[OR]4，95%可信区间[CI]：1.18-6.018）、心律失常（OR 3，95%CI：1.29-7.34）、血管通路改变（OR 4，95%CI：1.18-7.51）和舒张功能障碍（OR 5，95%CI：1.35-9.57）与 PAH 独立相关。
三分之一的血液透析患者存在 PAH，其与社会经济地位低下（无保障的资金、血管通路改变）和心血管并发症（心律失常、舒张功能障碍）独立相关。
