Pulmonary hypertension may raise kidney failure risk for patients with CKD

Navaneethan reports being an employee of the U.S. Department of Veterans Affairs; receiving personal fees from Bayer, Boehringer-Ingelheim, REATA and Tricida; and receiving grants from Keryx. Please see the study for all other authors’ relevant financial disclosures.

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Compared with patients who had chronic kidney disease alone, those who also had pulmonary hypertension were at greater risk for a variety of adverse outcomes, according to study findings.

Adverse outcomes included mortality, hospitalization, AKI and kidney failure.

Pulmonary hypertension with chronic kidney disease

Data were derived from Navaneethan SD, et al. Am J Kidney Dis. 2021;doi:10.1053/j.ajkd.2021.02.336.

“Most prior studies of [pulmonary hypertension] PH in CKD included relatively younger patients, and it is unclear how PH relates to outcomes among elderly patients with CKD, an age group at high risks for both CKD and PH,” Sankar D. Navaneethan, MD, MS, MPH, of the Selzman Institute for Kidney Health and Baylor College of Medicine, and colleagues wrote. “Further, associations of PH with important kidney outcomes such as kidney failure have not been systematically studied. Finally, PH poses a significant risk of hospitalization in CKD; however, the differential risk of cardiovascular versus non-cardiovascular hospitalizations in people with CKD and PH has not been examined.”

To investigate, the researchers assessed outcomes for 180,312 Medicare beneficiaries aged 67 years or older (median age, 80.7; 57.8% were women; 10.3% were African American), following patients for up to 5 years.

Adjustments were made for age, sex, race and comorbidities, with researchers noting that patients with pulmonary hypertension were more likely to have coronary artery disease, heart failure, obesity, interstitial lung disease and COPD.

During all periods of follow-up, patients with CKD and pulmonary hypertension had an increased risk for mortality (hazard ratios of 2.87, 1.56 and 1.47 at 1, 2 to 3 and 4 to 5 years, respectively) and hospitalization (relative risk of 4.61 for cardiovascular hospitalization and 2.62 for non-CV hospitalization at 1 year) compared with those who only had CKD.

The presence of pulmonary hypertension also demonstrated associations with increased risk for kidney failure at 1 year and 2 years to 3 years of follow-up, but not at 4 years to 5 years. Researchers partly attributed this to higher rates of AKI (some of which required dialysis within the following 30 to 90 days) experienced by patients with CKD and pulmonary hypertension.

“A novel finding of this report is the observed association of PH with increased risk for kidney failure, which has not been described previously,” Navaneethan and colleagues concluded. “Possible mechanisms to explain the higher kidney failure risk among those with PH include increased neuro-hormonal activation, right ventricular dysfunction, and higher comorbidity burden, all of which contribute to kidney disease progression in those with CKD … Additionally, several studies have reported an increased risk of sub-clinical and overt acute kidney injury among hospitalized patients with PH, which may contribute to further decline in kidney function over time. In this analysis, we observed a higher number of AKI events and AKI requiring dialysis support suggesting the impact of AKI episodes on the overall increased risk of kidney failure in this population.”