Key result
Pulmonary hypertension was associated with increased 5-year mortality in kidney transplant candidates (HR 2.11; 95% CI 1.48-3.03), particularly in the absence of elevated left atrial pressure.
Why the study?
Pulmonary hypertension is common and linked to death in advanced chronic kidney disease, but causes are heterogeneous and prognosis may vary by etiologic subtype.
Does the presence of pulmonary hypertension with or without elevated left atrial pressure affect 5-year mortality in patients evaluated for kidney transplantation?
Cohort (n=778)
No
Does the presence of pulmonary hypertension with or without elevated left atrial pressure affect 5-year mortality in patients evaluated for kidney transplantation?
Hazard Ratio: 2.11 (95% CI 1.48–3.03)
In kidney transplant candidates, pulmonary hypertension without elevated left atrial pressure is associated with a significantly higher risk of 5-year mortality compared to pulmonary hypertension with elevated left atrial pressure.
Supports pulmonary hypertension assessment for risk stratification in kidney transplant candidates; leaves open whether targeted therapy improves survival.
BACKGROUND: Pulmonary hypertension (PH) is frequently reported in patients with advanced chronic kidney disease and is associated with early allograft failure and death. However, the causes of PH are heterogeneous, and patient prognosis may vary by etiologic subtype. METHODS: Data from the University of North Carolina Cardiorenal Registry were examined to determine associations between PH, with or without elevated left atrial pressure (eLAP), and mortality in candidates for kidney transplantation. PH and eLAP were determined by Doppler echocardiography and by tissue Doppler imaging, respectively. RESULTS: From 2006 to 2013, 778 registry patients were screened preoperatively by echocardiography. Most patients were black (64%) and men (56%); the mean age was 56 years. PH was identified in 97 (12%) patients; of these, eLAP was prevalent in half. During a median follow-up of 4.4 years, 179 (23%) received a kidney transplant, and 195 (25%) died. After adjustments for demographics, comorbidities, dialysis vintage, and kidney transplantation, PH was associated with twice the 5-year mortality (hazard ratio [HR] = 2.11; 95% confidence interval [CI]: 1.48-3.03), with stronger associations in the absence of eLAP (HR = 2.87; 95% CI: 1.83-4.49) than with eLAP (HR = 1.11; 95% CI: 0.57-2.17), P for interaction = 0.01. CONCLUSIONS: The mortality risk associated with PH among patients with advanced chronic kidney disease appears to differ by etiology. Patients with PH in the absence of eLAP are at high risk of death and in need of focused attention. Future research efforts should investigate potential strategies to improve outcomes for these patients.
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Caughey et al. (2019) conducted a cohort in Advanced chronic kidney disease evaluated for kidney transplantation (n=778). Pulmonary hypertension vs. No pulmonary hypertension was evaluated on 5-year mortality (HR 2.11, 95% CI 1.48-3.03). Pulmonary hypertension was associated with increased 5-year mortality in kidney transplant candidates (HR 2.11; 95% CI 1.48-3.03), particularly in the absence of elevated left atrial pressure.
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