Abstract
Background
Pulmonary hypertension (PH) is associated with increased mortality in patients with
end-stage renal disease (ESRD). The prevalence of PH within ESRD as measured by right
heart catheterization (RHC) is poorly described, and the correlation of BNP to pulmonary
artery pressure (PAP) is unknown.
Methods
The renal transplant database at our center was used to identify adult ESRD patients
from July 2013 to July 2015 who had a plasma BNP level measurement and invasive hemodynamic
assessment by RHC within a 1-month period. Pulmonary hypertension was defined as a
mean pulmonary artery pressure (PAP) ≥ 25 mmHg. Multivariate linear regression analysis
was used to identify correlations between BNP and RHC parameters. To estimate the
utility of BNP in the screening of PH, a receiver-operating characteristic (ROC) curve
was generated.
Results
Eighty-eight patients were included in the study of which 43 had PH. Compared to patients
without PH, BNP was significantly higher within the PH cohort (1619 ± 2602 pg/ml vs.
352 ± 491 pg/ml). A statistically significant association (r [86] = 0.60, p<0.001) between plasma BNP and mean PAP was identified. ROC curve indicated
an acceptable predictive value of BNP in PH with a c-statistic of 0.800 (95% CI 0.708
– 0.892).
Conclusions
In ESRD patients being considered for renal transplantation, PH is highly prevalent
and BNP levels are elevated and significantly correlated with higher PAP. BNP may
be a useful non-invasive marker of PH in these patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of the Medical SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients.Kidney Int. 2009; 75: 969-975
- Prevalence and Mortality of Pulmonary Hypertension in ESRD: A Systematic Review and Meta-analysis.Lung. 2020; : 1-11
- Pulmonary hypertension in chronic renal failure patients.Am J Nephrol. 2008; 28: 990-997
Bozbas S, Akcay S, Altin C, et al. Pulmonary hypertension in patients with end-stage renal disease undergoing renal transplantation. Paper presented at: Transplantation proceedings2009.
- Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-study.PLoS One. 2012; 7: e35310
- Echocardiography versus right heart catheterization in class I pulmonary hypertension.Egyptian Journal of Chest Diseases and Tuberculosis. 2014; 63: 419-422
- A crossroads at the understanding of pulmonary hypertension in end stage renal disease. Heart & lung: the journal of critical care. 2021; 50: 232-233
- Comparison of brain natriuretic peptide (BNP) and NT-proBNP in screening for pulmonary arterial hypertension in patients with systemic sclerosis.The Journal of rheumatology. 2010; 37: 2064-2070
- Comparison of brain natriuretic peptide levels to simultaneously obtained right heart hemodynamics in stable outpatients with pulmonary arterial hypertension.Diseases. 2018; 6: 33
Moza A, Khan AR, Parashar R, et al. Pulmonary hypertension in renal transplant candidates: A systematic review and meta-analysis of the available evidence and a proposed algorithm for pre-transplant management. 2017.
- Lack of a tricuspid regurgitation Doppler signal and pulmonary hypertension by invasive measurement.Journal of the American Heart Association. 2018; 7e009362
- Pulmonary hypertension in patients with chronic kidney disease: invasive hemodynamic etiology and outcomes. Pulmonary circulation. 2017; 7: 674-683
- Pulmonary hypertension subtypes and mortality in CKD.Am J Kidney Dis. 2020; 75: 713-724
- Pulmonary Hypertension in Chronic Kidney Disease and End-Stage Renal Disease.Pulmonary Hypertension. Springer. 2020; : 173-194
Article Info
Publication History
Accepted:
April 15,
2022
Received:
May 30,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Southern Society for Clinical Investigation.
