Clinical analysis of hemodialysis patients with pulmonary arterial hypertension / 中华肾脏病杂志

ABSTRACT

Objective To investigate the prevalence ,clinical features and prognosis of pulmonary arterial hypertension (PAH) in maintenance bemodialysis (MHD) patients for early diagnosis and treatment. Methods Complete clinical data of 184 MHD patients in Beijing Chaoyang Hospital between January 2000 and December 2007 were retrospectively analyzed. PAH diagnosis depended on echocardiography. Results Sixty-five (35.3%) patients were found having PAH, including 31 females and 34 males, with mean (56.84±14.58) years old. The mean bemadialysis duration was (29.69±21.61) months. Among 65 patients with PAH, arteriovenous fistula was used in 61 patients and central venous catheter in 4 patients. The systolic pulmonary arterial pressure (SPAP) was (44.56±8.25) mm Hg (1 mm Hg=0.133 kPa) in PAH group, which was significantly higher than (30.28±3.92) mm Hg in non-PAH group. There were significant differences of interval dialysis weight gain (IDWG), Hb, Hct, right atrial diameter, pulmonary artery diameter and right ventricular diameter between PAH group and non-PAH group (all P<0.05). Multivariate analysis revealed anemia, IDWG and right atrial diameter were independent factors (P< 0.05). There were no significant differences of age, dialysis duration, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH) between two groups. Conclusions PAH is a common complication of MHD patients. Patients with mild PAH had few clinical manifestations and good therapeutic responses, but severe PAH may be associated with poor prognos is. Doppler echocardiography should be performed periodically to detect PAH in MHD patients.