Abstract

Background:To study the prevalence of Pulmonary Hypertension (PH) in patients with Chronic Kidney Disease (CKD).
Materials and Methods: The present study assessed the prevalence of PH in 50 patients with CKD, at DR.PSIMS & RF, Chinnavutpalli, Gannavaram.
Results: The commonly affected age group in study population was 31-50 years. The mean age of patients was 48.98±12.53years. Diabetes Mellitus was present in 15 (30%) and Hypertension in 48 (96%).  Majority of the patients were in CKD stage 5, i.e.,46 (92%), CKD stage 4 -3 (6%), CKD stage 3- 1(2%). The prevalence of PH in CKD is 22 (44%). PH was not found in the patient with CKD stage 3. PH was found in 2 of the 3(66.6%) patients with CKD stage 4. Out of the 46 CKD stage 5 patients, 20 (43.4%) had PH. With reference to the severity of PH with CKD, the two patients of PH  CKD stage 4 had moderate PH . Out of the 20 patients of PH with CKD stage 5, 10 patients had mild PH, 9 with moderate PH and 1 with severe PHOn Chest X ray, descending right pulmonary artery dilatation and cardiomegaly were seen in more number of patients with PH, compared to those without PH. (p<0.001). In this study, LV systolic dysfunction was present in 18 out of 50 patients (36%). Among 22 patients with PH, it was present in 13 (59.09%). Among 28 patients without PH, it was present in 5 (17.85%). LV systolic dysfunction was significantly higher among the patients with PH compared to those without PH. The mean EF of all patients with CKD is 55.62± 9.54. The mean EF of patients with PH and without PH in the study was 50.50±9.78% and 59.64±7.26% respectively. (p<0.02). LV diastolic dysfunction was present in 41 out of 50 patients (82%). Among 22 patients with PH, it was present in 20 (90.9%). Among 28 patients without PH, it was present in 21 (75%). Prevalence of LV diastolic dysfunction was significantly higher among the patients with PH, compared to those without PH. RV dysfunction was present in 1(3.6%) and in 10 (45.5%) in patients without PH and in patients with PH respectively. Significant difference was found with RV dysfunction more prominent in patients with PH than in patients without PH (p<0.001). 64%of the patients studied had CKD of less than 6 months including 24%of new cases. 16%of the patients had CKD between 6 months and 1year. 20% had CKD of more than 1yr. In relation to PH, out of the 12 new cases of CKD,7 (31.8%) had PH and 5(17.9%)were without PH. Of the 20 patients having history of CKD less than 6 months (excluding new cases), 7 (31.8%) had PH and 13 (46.4%) were without PH. Out of the 8 patients  of CKD between 6 months and 1 year,4(18.2%) had PH and  4(14.3%)were without PH. In patients having CKD of more than 1 year, 4 (18.2%) had PH and 6 (21.4%) were without PH.
Conclusion: The study showed that PH is common in patients with CKD. Left Ventricular systolic and diastolic dysfunctions are strongly related to the outcome of these patients. Unexplained dyspnoea in patients with CKD must be evaluated for PHPulmonary Hypertension, CKD, Chest X-Ray, Left Ventricle, Mortality, ECG, 2D-Echo