Pulmonary Hypertension Identified as Risk Factor for Cardiovascular Disease in Dialysis Patients
In a new study entitled “Relationship between pulmonary hypertension, peripheral vascular calcification, and major cardiovascular events in dialysis patients,” the authors identify a relation between pulmonary hypertension and increase risk for cardiovascular problems in dialysis patients. The study was published in the journal for Kidney Research and Clinical Practice.
Pulmonary hypertension (PH), a condition characterized by high blood pressure in the arteries of the lungs, is increasingly described as a complication of chronic kidney disease, and well established in cardiac, pulmonary, and other diseases. In kidney disease patients, PH is recognized to occur in 18.8% to 68.8% of those performing hemodialysis and it can reach 42% of those in peritoneal dialysis (hemodialysis and peritoneal dialysis are both used to treat kidney failure). The underlying causes of PH in these patients were suggested to occur due to vascular calcifications, contributing to an increased cardiovascular mortality.
In this new study, a research team investigated how PH associates with peripheral vascular calcifications (VCs) and other cardiovascular conditions in dialysis patients. To this end, they performed a retrospective study where they analyzed 172 end-stage renal disease (ESRD) patients either undergoing hemodialysis (n= 84) or peritoneal dialysis (n=88). The team defined patients suffering from PH when their pulmonary artery systolic pressure was higher than 37 mmHg (as measured by echocardiography, a test that uses sound waves to create pictures of the heart) and also determined vascular calcification events using the Simple Vascular Calcification Score (SVCS).
The authors found PH was particularly prevalent in hemodialysis patients when compared to dialysis patients. The team identified that severe vascular calcifications are an independent risk factor for PH. In dialysis patients, PH occurrence was found to be an independent predictor of serious cardiovascular events (such as acute myocardial infarction or stroke), in addition to other known factors, such as anemia, severe vascular calcification or old age. While the mechanisms underlying PH in dialysis patients resulting in higher cardiovascular events is unknown, the team hypothesizes that the increase in vascular calcification might lead to PH development, since it is well established vascular calcifications are a risk factor for cardiovascular disease also.
The research team highlights that in dialysis patients with PH, clinicians should pay particular attention to those with vascular calcifications due to the increased risk for serious cardiovascular problems.