Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2021  |  Volume : 32  |  Issue : 1  |  Page : 280--283

Pulmonary Artery Hypertension in Patients on Peritoneal Dialysis


E Annaiah1, Sivaparvathi Karanam2, N Sharvani1, Sharan B Singh1, V Vanajakshamma3, M Hemalatha2, C Latha2, V Sivakumar2,  
1 Department of Physiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
3 Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Correspondence Address:
Sivaparvathi Karanam
Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh
India




How to cite this article:
Annaiah E, Karanam S, Sharvani N, Singh SB, Vanajakshamma V, Hemalatha M, Latha C, Sivakumar V. Pulmonary Artery Hypertension in Patients on Peritoneal Dialysis.Saudi J Kidney Dis Transpl 2021;32:280-283


How to cite this URL:
Annaiah E, Karanam S, Sharvani N, Singh SB, Vanajakshamma V, Hemalatha M, Latha C, Sivakumar V. Pulmonary Artery Hypertension in Patients on Peritoneal Dialysis. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2021 Sep 21 ];32:280-283
Available from: https://www.sjkdt.org/text.asp?2021/32/1/280/318543


Full Text



To the Editor,

Pulmonary arterial hypertension (PAH) is a distinct disease in patients with end-stage renal disease (ESRD) who were on renal replacement therapy [hemodialysis (HD), peritoneal dialysis (PD), transplantation] with discrete demographics, etiologies and manifestations in each group. PAH is gaining importance in patients of chronic kidney disease and ESRD in recent times, because of its significance on morbidity and mortality.

The available literature on PAH in ESRD and HD was vast, with an estimated prevalence ranging from 40% to 50% and the frequency of PAH was reported to be higher in HD compared to PD due to the presence of arteriovenous fistula (AVF).[1] Several factors were implicated including anemia, fluid overload, myocardial dysfunction, increased pulmonary blood flow due to shunting across AVF in HD patients, exposure to dialysis membranes, oxidative stress, endothelial dysfunction hyperparathyroidism, with vascular calcification to play a role in the pathogenesis of PAH.[2] However the data on PAH in PD patients is sparse and hence this study was undertaken to analyze our PD patients on the presence and profile of PAH.

It was a cross-sectional observational study conducted during a period of three months, at our unit. We screened a cohort of 100 ESRD patients on PD, who were at least on PD for three months and on regular follow-up at our PD unit without any peritonitis in the preceding three months. All the baseline demographic clinical, biochemical parameters were collected in a pro forma and pulmonary hypertension was diagnosed by two-dimensional (2D) echo-cardiographic measurement by a dedicated cardiologist.

A total of 100 patients were included for the study and PAH was defined as mean pulmonary artery pressure greater than 25 mm Hg in our study.[3] The baseline demographic and laboratory parameters of the study population were shown in [Table 1]. The mean age of the patients was 50.4 ± 15 years. The majority of the patients were males (67%) with an average duration of PD of 18.9 months. We have divided our population in diabetics and nondiabetics for subgroup analysis and both of them represented equally in our study (50 each). In total PAH was seen in 59% of the screened patients and among them, diabetics were 41 (69.4%).{Table 1}

Comparison of the various clinical, biochemical parameters of patients with PAH and without PAH [Table 2], it was observed that patients with PAH were more aged and the majority of them were diabetics (69%) and were on loner duration of PD when compared to those without PAH. On 2D echo observations, the mean pulmonary artery pressure of patients with PAH was 40.42 ± 6 mm Hg.{Table 2}

On subgroup analysis of PAH between diabetics and nondiabetics it was seen diabetics with PAH were also more aged, on longer duration of PD, but their mean pulmonary artery pressures were high compared to nondiabetics with PAH, which was statistically significant, indicating that PAH is a severe disease in diabetic PD patients. Further it was observed that the elderly had a higher mean pulmonary artery pressure compared to those aged <60 and females with PAH had lower mean serum phosphorus levels compared to males with PAH [Table 3].{Table 3}

We have analyzed the lipid parameters among patients with and without PAH and observed that there was no significant difference between lipid profile in patients with PAH [Table 4], however dyslipidemia as expressed by atherogenic ratios like total cholesterol/high-density lipoprotein (HDL), non-HDL/HDL, showed a significant correlation with PAH in patients on PD.{Table 4}

It was observed that patients with PAH had more right atrial and right ventricular dilatation and associated tricuspid regurgitation as well as significant left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD) and more association with heart failure and pericardial effusion on 2D echo [Table 5].{Table 5}

To conclude PAH was observed in 59 % of our studied PD patients. Age, longer duration of dialysis, presence of diabetes, higher serum urea concentrations, LVH and LVDD on 2D echo were found to be significant risk factors for PAH in patients on PD. Dyslipidemia as expressed by various atherogenic ratios was associated with PAH, hence dietary and pharmacological management of dyslipidemia is of potential benefit in this group of patients. It was also noted that elderly and diabetics with PAH have higher mean pulmonary artery pressure (severe disease) when compared to nondiabetics and patients with age <60 years of age and females with PAH had hypo-phosphatemia. It is prudent to consider regular follow-up with 2D echo examination of this specific group of the population who are predisposed to PAH.

Conflict of interest: None declared.

References

1Fabbian F, Cantelli S, Molino C, Pala M, Longhini C, Portaluppi F. Pulmonary hypertension in dialysis patients: A cross-sectional Italian study. Int J Nephrol 2010;2011:283475.
2Suresh H, Arun BS, Moger V, Vijayalaxmi PB, Murali Mohan KT. A prospective study of pulmonary hypertension in patients with chronic kidney disease: A new and pernicious complication. Indian J Nephrol 2018;28:127-34.
3Bolignano D, Rastelli S, Agarwal R, et al. Pulmonary hypertension in CKD. Am J Kidney Dis 2013;61:612-22.