Key result
Long-term APD linked to a ~17 mmHg drop in sPAP for ESRD patients with PAH.
Why the study?
Pulmonary arterial hypertension in end-stage renal disease carries important prognostic and therapeutic consequences, but its prevalence and longitudinal evolution during automated peritoneal dialysis required evaluation.
Does automated peritoneal dialysis improve pulmonary artery pressure and cardiac function in patients with end-stage renal disease?
Cohort (n=31)
No
Does automated peritoneal dialysis improve pulmonary artery pressure and cardiac function in patients with end-stage renal disease?
Absolute Event Rate: 23.55% vs 40.75%
p-value: p=0.001
Long-term automated peritoneal dialysis in patients with end-stage renal disease is associated with significant reductions in pulmonary artery pressure and improvements in left ventricular ejection fraction.
APD may lower PAP and improve LVEF in ESRD; leaves open its role in PAH management pending larger prospective trials.
BACKGROUND: Pulmonary arterial hypertension (PAH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PAH among patients with ESRD treated with automated peritoneal dialysis (APD), investigated the effect of different variables and compared pulmonary artery pressure and cardiac function at the beginning and end of the study. METHODS: This is a 5-year study in which 31 ESRD patients on APD were recruited after fulfilling inclusion criteria. Blood samples were collected from all patients for the biochemical and hematological data at the beginning of the study and every month and at the study termination. Total body water (TBW) and extracellular water (ECW) were calculated using Watson's and Bird's calculation methods. All patients were followed-up at 3-month interval for cardiac evaluation. Logistic regression analysis was used to assess the relation between different variables and PAH. RESULTS: The mean age of the study population (n = 31) was 51.23 ± 15.24 years. PAH was found in 24.2% of the patients. Mean systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) were significantly higher in the APD patients at study initiation than at the end of the study (40.75 + 10.61 vs 23.55 + 9.20 and 29.66 + 11.35 vs 18.24 + 6.75 mmHg respectively, p = 0.001). The median ejection fraction was significantly lower in patients with PAH at zero point than at study termination [31% (27-34) vs 50% (46-52), p = 0.002]. Hypervolemia decreased significantly at the end of study (p < 0.001) and correlated positively with the PAP (r = 0.371 and r = 0.369), p = 0.002). sPAP correlated with left ventricular mass index, hemoglobin level, and duration on APD. CONCLUSIONS: Long term APD (> 1 years) seemed to decrease pulmonary arterial pressure, right atrial pressure and improve left ventricular ejection fraction (LVEF). Risk factors for PAH in ESRD were hypervolemia, abnormal ECHO findings and low hemoglobin levels. Clinical and echocardiographic abnormalities and complications are not uncommon among ESRD patients with PAH. Identification of those patients on transthoracic echocardiography may warrant further attention to treatment with APD.
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Al‐Hwiesh et al. (2022) conducted a cohort in End-stage renal disease with pulmonary arterial hypertension (n=31). Automated peritoneal dialysis (APD) vs. Baseline (study initiation) was evaluated on Systolic pulmonary artery pressure (sPAP) in mmHg (p=0.001). Long-term automated peritoneal dialysis significantly decreased mean systolic pulmonary artery pressure from 40.75 mmHg to 23.55 mmHg in patients with end-stage renal disease and pulmonary arterial hypertension.
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