Key result
Pulmonary hypertension in hemodialysis patients is linked to heart failure and overhydration, affecting ~34% of cases.
Why the study?
To examine pulmonary hypertension and right ventricular-pulmonary arterial coupling, their relations with dialysis access flow and hydration, associated structural heart changes, and the prevalence, etiology, and severity of pulmonary hypertension in chronic hemodialysis patients.
Cross-Sectional (n=336)
Yes
In chronic hemodialysis patients, pulmonary hypertension and RV-PA uncoupling are strongly associated with fluid overload and heart failure rather than arteriovenous access flow, highlighting the importance of optimizing volume status.
May support prioritizing volume management over access flow in hemodialysis pulmonary hypertension; leaves open prospective trials to confirm outcomes.
OBJECTIVES: This cross-sectional analysis from the CZecking Heart Failure in patients with advanced Chronic Kidney Disease trial (ISRCTN18275480) examined pulmonary hypertension and right ventricular-pulmonary arterial coupling in patients on chronic hemodialysis. The aims of this analysis were: 1. To analyze relations between pulmonary hypertension and right ventricular-pulmonary arterial coupling with dialysis access flow and current hydration; 2. To analyze structural heart changes associated with right ventricular-pulmonary arterial uncoupling; 3. To reveal the prevalence, etiology and severity of pulmonary hypertension in the Czech hemodialysis population. METHODS: We performed expert echocardiography, vascular access flow measurements, bioimpedance analysis, and laboratory testing in 336 hemodialysis patients. CONCLUSION: These findings suggest that optimizing volume status and treating heart failure should be prioritized in hemodialysis patients to prevent pulmonary hypertension progression and right ventricular-pulmonary arterial uncoupling.
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Salajová et al. (2025) conducted a cross-sectional in Chronic hemodialysis (n=336). Pulmonary hypertension vs. No pulmonary hypertension was evaluated on Heart failure prevalence (p=<0.0001). In hemodialysis patients, pulmonary hypertension was present in 34% of cases and was strongly associated with heart failure (79% vs 37.5%, p<0.0001) and overhydration, rather than dialysis access flow.
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