Nephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952, Saudi Arabia.
Cardiology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
BMC Nephrol. 2022 Dec 5;23(1):386. doi: 10.1186/s12882-022-02998-y.
Pulmonary arterial hypertension (PAH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PAH among patients with ESRD treated with automated peritoneal dialysis (APD), investigated the effect of different variables and compared pulmonary artery pressure and cardiac function at the beginning and end of the study.
This is a 5-year study in which 31 ESRD patients on APD were recruited after fulfilling inclusion criteria. Blood samples were collected from all patients for the biochemical and hematological data at the beginning of the study and every month and at the study termination. Total body water (TBW) and extracellular water (ECW) were calculated using Watson's and Bird's calculation methods. All patients were followed-up at 3-month interval for cardiac evaluation. Logistic regression analysis was used to assess the relation between different variables and PAH.
The mean age of the study population (n = 31) was 51.23 ± 15.24 years. PAH was found in 24.2% of the patients. Mean systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) were significantly higher in the APD patients at study initiation than at the end of the study (40.75 + 10.61 vs 23.55 + 9.20 and 29.66 + 11.35 vs 18.24 + 6.75 mmHg respectively, p = 0.001). The median ejection fraction was significantly lower in patients with PAH at zero point than at study termination [31% (27-34) vs 50% (46-52), p = 0.002]. Hypervolemia decreased significantly at the end of study (p < 0.001) and correlated positively with the PAP (r = 0.371 and r = 0.369), p = 0.002). sPAP correlated with left ventricular mass index, hemoglobin level, and duration on APD.
Long term APD (> 1 years) seemed to decrease pulmonary arterial pressure, right atrial pressure and improve left ventricular ejection fraction (LVEF). Risk factors for PAH in ESRD were hypervolemia, abnormal ECHO findings and low hemoglobin levels. Clinical and echocardiographic abnormalities and complications are not uncommon among ESRD patients with PAH. Identification of those patients on transthoracic echocardiography may warrant further attention to treatment with APD.
终末期肾病（ESRD）患者并发肺动脉高压（PAH）具有重要的预后和治疗意义。本研究旨在评估接受自动化腹膜透析（APD）治疗的 ESRD 患者中 PAH 的患病率，分析不同变量的影响，并比较研究开始和结束时的肺动脉压和心功能。
这是一项为期 5 年的研究，共纳入 31 例符合纳入标准的 ESRD 合并 PAH 患者。所有患者在研究开始时及此后每月和研究结束时采集血样，进行生化和血液学数据检测。应用 Watson 和 Bird 两种计算方法计算患者的总体水（TBW）和细胞外水（ECW）。所有患者均在 3 个月时进行心脏评估。应用 logistic 回归分析评估不同变量与 PAH 的关系。
本研究共纳入 31 例患者，平均年龄为 51.23±15.24 岁。24.2%的患者存在 PAH。与研究结束时相比，APD 患者在研究开始时的收缩压肺动脉压（sPAP）和平均肺动脉压（mPAP）显著升高[分别为 40.75±10.61mmHg 和 29.66±11.35mmHg 比 23.55±9.20mmHg 和 18.24±6.75mmHg，p=0.001]。PAH 患者的中位射血分数在零时显著低于研究结束时[31%（27-34）比 50%（46-52），p=0.002]。研究结束时患者的血容量显著减少（p<0.001），且与 PAP 呈正相关（r=0.371 和 r=0.369，p=0.002）。sPAP 与左心室质量指数、血红蛋白水平和 APD 治疗时间有关。
APD 治疗>1 年可能会降低肺动脉压、右心房压并改善左心室射血分数（LVEF）。ESRD 合并 PAH 的危险因素包括血容量过多、超声心动图异常和低血红蛋白水平。ESRD 合并 PAH 患者的临床和超声心动图异常及并发症并不少见。在经胸超声心动图中识别这些患者可能需要进一步关注 APD 治疗。
