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Prevalence and Mortality of Pulmonary Hypertension in ESRD: A Systematic Review and Meta-analysis

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Abstract

Introduction

Pulmonary hypertension (PH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PH among patients with ESRD and compared mortality between ESRD patients with and without PH.

Methods

Two independent reviewers searched three databases using a search strategy built around the medical subject headings of “hypertension, pulmonary” and “kidney failure, chronic.” Keywords and synonyms were also used. Study selection criteria included (1) Enrollment of patients with ESRD undergoing hemodialysis or peritoneal dialysis, (2) Assessment for the presence of PH using transthoracic echocardiography, and (3) Determination of PH prevalence or associated mortality. The primary outcomes were prevalence of PH or associated mortality. The Grading, Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence.

Results

The initial search identified 1046 publications, from which 41 studies were selected. The median prevalence of PH identified by echocardiographic criteria among patients with ESRD was 38% (range 8% to 70%), and was significantly increased in patients undergoing hemodialysis (HD) (median 40%, range 16–70%) as compared with peritoneal dialysis (PD) (median 19%, range 8–37%). Meta-analysis demonstrated that overall mortality was higher among ESRD patients with echocardiographic evidence of PH than ESRD patients without echocardiographic evidence of PH (RR 2.02; 95% CI 1.70–2.40).

Conclusions

Echocardiographic evidence of PH is common among ESRD patients undergoing dialysis and associated with increased mortality. Identification of those patients with evidence of pulmonary hypertension on transthoracic echocardiography may warrant further evaluation and treatment.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, 02215, MA, USA

    Noah C. Schoenberg

  2. Pulmonary, Critical Care, Allergy & Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA

    Rahul G. Argula

  3. The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA

    Elizabeth S. Klings & Kevin C. Wilson

  4. American Thoracic Society, New York, NY, USA

    Kevin C. Wilson

  5. Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Boston, MA, USA

    Harrison W. Farber

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  1. Noah C. Schoenberg
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Contributions

NS: Conceptualization, Data Collection, Data Analysis, Manuscript Writing, Guarantor. RA: Data Collection, Manuscript Editing. EK: Manuscript Editing. KW: Conceptualization, Data Analysis, Manuscript Editing. HF: Conceptualization, Manuscript Editing.

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Correspondence to Noah C. Schoenberg.

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Schoenberg, N.C., Argula, R.G., Klings, E.S. et al. Prevalence and Mortality of Pulmonary Hypertension in ESRD: A Systematic Review and Meta-analysis. Lung 198, 535–545 (2020). https://doi.org/10.1007/s00408-020-00355-0

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