Association Between Invasive Cardiac Hemodynamics and Kidney Function in Patients with Pulmonary Hypertension

BACKGROUND: CKD is common in patients with pulmonary hypertension and is associated with increased risk of mortality. We hypothesized that worse invasive hemodynamics would be associated with the development of CKD. METHODS: 9,195 patients enrolled in the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension with incident pulmonary hypertension and at least one creatinine value were included. Logistic regression and Cox proportional hazards models were used to evaluate the association between each hemodynamic parameter, baseline CKD, and incident CKD, respectively. Models were adjusted for age, sex, body mass index, diabetes, and arterial hypertension and longitudinal models were adjusted for baseline eGFR. RESULTS: At baseline, 4,161 (45.3%) participants had CKD stage 3. Higher right atrial pressure, pulmonary arterial wedge pressure, mean pulmonary artery pressure, pulmonary vascular resistance and lower cardiac index were associated with a higher prevalence of CKD. Over a median follow-up duration of 2.5 [IQR 0.9, 5.2] years among 4,125 participants with eGFR ≥60 ml/min/1.73m2 at baseline and multiple creatinine measurements, 1,859 (45.1%) developed incident CKD stage 3a. Higher right atrial pressure (HR 1.12 [1.06, 1.18] per 5 mmHg) and higher pulmonary vascular resistance (HR 1.12 [1.05, 1.18] per 1 WU) and lower cardiac index (HR 0.86 [0.80, 0.93] per 1L/min/m2) were associated with the development of CKD. CONCLUSIONS: The incidence of CKD is high in patients with pulmonary hypertension. Worse hemodynamic markers are associated with lower eGFR and increased risk of development of CKD in patients with pulmonary hypertension.