What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Chronic Kidney Disease (Stages 3-5) (n=120). Primary outcome: Prevalence of echocardiographically defined pulmonary hypertension (PASP >35 mmHg).

What question did this study set out to answer?

This study aims to determine the prevalence of pulmonary hypertension (PH) in chronic kidney disease (CKD) and identify associated echocardiographic features.

May 13, 2026Open Access

Prevalence and Associated Echocardiographic Findings of Pulmonary Hypertension in Chronic Kidney Disease: A Cross-Sectional Study

Key Result

Echocardiographically defined pulmonary hypertension was present in 56.7% of patients with stage 3 to 5 chronic kidney disease and was associated with advanced CKD and diastolic dysfunction.

Key Points

This study aims to determine the prevalence of pulmonary hypertension (PH) in chronic kidney disease (CKD) and identify associated echocardiographic features.
Cross-sectional study involving 120 adults with stages 3-5 CKD
Patients evaluated for echocardiographic features of PH between November 2024 and December 2025
PH defined by estimated pulmonary artery systolic pressure (PASP) >35 mmHg.
56.7% of patients (68 out of 120) had PH, with classifications of mild, moderate, and severe
Patients with PH were more likely to be at stage 5 CKD, dialysis dependent, experience volume overload, and exhibit diastolic dysfunction
Non-definitional findings included lower tricuspid annular plane systolic excursion, larger right atrial diameter, and increased diastolic dysfunction.

Study Design

Type

Cross-Sectional (n=120)

Multicenter

Structured PICO

What is the prevalence of echocardiographically defined pulmonary hypertension and its associated echocardiographic findings in adults with stages 3-5 chronic kidney disease?

Population

120 adults with stages 3-5 chronic kidney disease (CKD), including conservatively managed patients and those receiving maintenance hemodialysis.

Outcome

Prevalence of echocardiographically defined pulmonary hypertension (estimated PASP >35 mmHg) and associated echocardiographic variables.surrogate

Pulmonary hypertension is highly prevalent (56.7%) in patients with stages 3-5 chronic kidney disease and is associated with right heart structural changes and left ventricular diastolic dysfunction.

Limitations

Cross-sectional design precludes causal inference and limits conclusions to association rather than temporal prediction
Single center with a modest sample size, which may limit generalizability and increase the risk of model overfitting
No formal external validation was performed
PH was defined echocardiographically rather than by right-heart catheterization, which may have introduced misclassification
Volume status was assessed clinically rather than by objective hemodynamic or imaging-based methods
Potential selection bias cannot be excluded
Important variables such as left atrial volume, arteriovenous fistula flow, biomarkers, and invasive hemodynamic measurements were not available

Abstract

Background: Pulmonary hypertension (PH) is an increasingly recognized cardiovascular complication in chronic kidney disease (CKD), yet the echocardiographic features associated with its presence remain insufficiently characterized in routine nephrology practice. This study determined the prevalence of echocardiographically defined PH in CKD and examined echocardiographic variables associated with its presence. Methodology: This cross-sectional study included 120 adults with stages 3-5 CKD, including both conservatively managed patients and those receiving maintenance hemodialysis, evaluated between November 2024 and December 2025. PH was defined echocardiographically as an estimated pulmonary artery systolic pressure (PASP) >35 mmHg. Clinical, renal, and echocardiographic variables were compared between patients with and without PH. Because the estimated PASP was derived from tricuspid regurgitation velocity (TRV) and estimated right atrial pressure (RAP), these variables were considered definitional components of PH classification rather than independent associated findings. Exploratory analyses focused on non-definitional clinical and echocardiographic variables. Results: PH was present in 68 (56.7%) patients, while 52 (43.3%) had no PH. Mild PH was observed in 21 (17.5%), moderate PH in 25 (20.8%), and severe PH in 22 (18.3%). Patients with PH more frequently had stage 5 CKD (40, 58.8%, vs. 14, 26.9%), dialysis dependence (38, 55.9%, vs. 16, 30.8%), volume overload (41, 60.3%, vs. 16, 30.8%), and diastolic dysfunction (53, 77.9%, vs. 22, 42.3%). Among non-definitional echocardiographic findings, patients with PH had lower tricuspid annular plane systolic excursion, larger right atrial diameter, and more frequent diastolic dysfunction. TRV and estimated RAP were not interpreted as independent associated variables because they contributed directly to PASP estimation. Conclusions: PH was present in 68 of 120 patients with CKD, corresponding to a prevalence of 56.7%. Because PH was classified using estimated PASP derived from TRV and estimated RAP, these variables were not interpreted as independent echocardiographic correlates. Non-definitional echocardiographic findings associated with PH included lower tricuspid annular plane systolic excursion, larger right atrial size, and more frequent diastolic dysfunction. These findings support careful multiparameter echocardiographic assessment in CKD but should be interpreted as associative rather than predictive evidence.

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