A Study of Pulmonary Arterial Pressure with Two Dimensional Trans Thoracic Echocardiography in Patient With Chronic Kidney Disease

Abstract

Introduction
This study focuses on assessing pulmonary arterial hypertension (PAH) in individuals diagnosed with chronic kidney disease (CKD), specifically exploring its prevalence across different CKD stages and its association with hemodialysis. The investigation conducted at Krishna Institute of Medical Sciences over two years involved 100 CKD patients, aiming to shed light on the frequency and correlations of PAH within this population.
Aim
To study pulmonary arterial pressure in patients diagnosed with chronic kidney disease.
Objectives
To determine the incidence of pulmonary arterial pressure in chronic kidney disease.
To study the association of pulmonary arterial pressure with stages of chronic kidney disease. To study the association of pulmonary arterial pressure with patients on hemodialysis.
Materials and methods
This study was conducted as a single-center cross-sectional observational study at Krishna Institute of Medical Sciences, Karad, Maharashtra.
Study population
All patients who attended the OPD and IPD of Krishna Hospital, Karad, diagnosed with chronic kidney disease, were studied.
Study duration
The investigation was carried out from 22nd September 2022 to 24th March 2024.
Results: Prevalence across CKD stages: PAH prevalence was notably higher in advanced CKD stages (IV and V) compared to earlier stages (III). Stage V CKD showed the highest incidence of PAH (72.58%), followed by Stage IV (12.00%) and Stage III (4.00%). This association was statistically significant (p < 0.0001), emphasizing the link between PAH and CKD progression.
Association with hemodialysis duration: The study observed a trend towards increased PAH prevalence with longer durations of hemodialysis. Patients undergoing hemodialysis for over 12 months exhibited a higher incidence of PAH (50.0%) compared to those with shorter durations (< 6 months and 6-12 months), indicating a potential influence of hemodialysis on PAH development in CKD patients.

Correlations with clinical and laboratory parameters: PAH was associated with higher systolic and diastolic blood pressures, lower estimated glomerular filtration rate (eGFR), elevated blood urea nitrogen (BUN), serum phosphorus, creatinine, and calcium levels. These parameters highlight the clinical relevance of monitoring cardiovascular and renal markers in PAH management among CKD patients.
Age and comorbidity associations: Advanced age (> 60 years) was significantly associated with higher PAH prevalence, underscoring age as a risk factor for PAH development in CKD. However, no significant correlations were found between PAH and common comorbidities like diabetes mellitus (DM) and hypertension (HTN) in this cohort.
Study limitations and implications: The study acknowledges limitations such as its cross-sectional design and the need for larger, longitudinal studies to validate findings. Nevertheless, the results provide critical insights into PAH prevalence patterns and its clinical correlates in CKD patients, emphasizing the importance of early detection and tailored management strategies.
Conclusion : This study contributes to understanding the complex interplay between CKD and PAH, highlighting the need for comprehensive cardiovascular assessments in CKD management protocols. Further research is warranted to elucidate the mechanistic links and optimal therapeutic approaches for mitigating PAH's impact on CKD progression and patient outcomes.
Categories: Cardiology, Internal Medicine, Nephrology