Author + information
- Jonathan Wolfe,
- Gavin Hickey,
- Andrew Althouse,
- Michael Sharbaugh,
- Deepak Kumar Pasupula,
- Dustin Kliner,
- Michael Mathier and
- Prem Soman
Introduction: The multifactorial etiology of pulmonary hypertension (PH) in end-stage renal disease (ESRD) includes patients with and without elevated pulmonary vascular resistance (PVR). We explored the prognostic implication of this distinction.
Methods: We evaluated pre-transplant ESRD patients in a specialty cardio-renal clinic who underwent right heart catheterization. Demographics, clinical data, and test results were analyzed. All-cause mortality data was obtained. Mean follow up was 5.2 years.
Results: Of the 150 patients evaluated, 88 (59%) had mean PA pressure > 25 mm Hg. Of these, 70 had PVR ≤ 3 and 18 had PVR > 3. The low PVR in the majority of patients with elevated PA pressure is attributable to high cardiac output. Thirty-four patients were transplanted, and 68 died. Survival analysis demonstrated a significant prognostic effect of an elevated PVR in patients with high mean PA pressures (HR=2.26, 95% CI 1.07-4.77, p=0.03; See Figure), while patients with high mean PA pressure and normal PVR had equivalent survival to those with normal PA pressure. The effect was modestly attenuated when adjusting for transplant, but remains notable (HR=1.86, 95% CI 0.88-3.93, p=0.10) considering the small sample size.
Conclusion: Despite the high prevalence of PH in ESRD patients, elevated PVR is rare and is a determinant of prognosis in patients with high mean PA pressures. Patients with lower PVR had survival equivalent to those with normal PA pressure.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Predicting the Future: Observations and Discoveries From Registries and Databases
Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 1230-003
- 2017 American College of Cardiology Foundation