International Urology and Nephrology

, Volume 50, Issue 8, pp 1497–1504 | Cite as

Prevalence of pulmonary hypertension in patients with chronic kidney disease without dialysis: a meta-analysis

  • Weifeng Shang
  • Yuanyuan Li
  • Yali Ren
  • Wei Li
  • HongLan Wei
  • Junwu Dong
Nephrology - Original Paper



Recent epidemiological evidence attempts to demonstrate the risk of pulmonary hypertension (PH) among patients with chronic kidney disease (CKD) without dialysis, but prevalence estimates of PH in CKD without dialysis vary widely in the existing studies. This meta-analysis was to summarize the point prevalence of PH in adults with CKD without dialysis.


PubMed, EMBASE, the Cochrane Collaboration, and the reference lists of relevant articles were searched to identify eligible studies. We used a random-effect meta-analysis model to estimate the prevalence of PH. Associations were tested in subgroups and meta-regression analyses. We also performed sensitivity analyses and assessments of publishing bias.


Twenty-one observational studies (n = 8012 participants) were included in this meta-analysis. The result of analysis in random-effect model showed that the pooled prevalence was 32% (95% CI 23–42%), with significant heterogeneity between these studies (I2 = 98%, P < 0.01). Stratified analyses found that the study design, region, sample size, year of publication, and definition of PH based on PASP ≥ 35 mmHg may explain the variation between studies. Sensitivity analysis further demonstrated the results to be robust. There was no evidence of publication bias.


PH is highly prevalent in patients with CKD without dialysis. Owing to the high heterogeneity, future well-designed and large prospective studies are encouraged to confirm the findings and definitively clarify the potential biological mechanisms.


Pulmonary hypertension Prevalence CKD Meta-analysis 



Chronic kidney disease


Pulmonary hypertension


Pulmonary artery systolic pressure


Right heart catheterization


Tricuspid regurgitant velocity


Author contributions

JD and WS conceived and designed the study. WS, YR, and YL screened the abstract and full text, extracted the data, assessed the studies, and drafted the manuscript. WS, YL, WL, and HW performed the statistical analyses. WS, and JD revised the manuscript. All authors read the manuscript and approved the final version.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

11255_2018_1853_MOESM1_ESM.pdf (161 kb)
Supplementary material 1 (PDF 160 kb)


  1. 1.
    Chadban SJ, Briganti EM, Kerr PG, Dunstan DW, Welborn TA, Zimmet PZ, Atkins RC (2003) Prevalence of kidney damage in Australian adults: the AusDiab kidney study. J Am Soc Nephrol 14(7 Suppl 2):S131–S138CrossRefPubMedGoogle Scholar
  2. 2.
    Chen J, Wildman RP, Gu D, Kusek JW, Spruill M, Reynolds K, Liu D, Hamm LL, Whelton PK, He J (2005) Prevalence of decreased kidney function in Chinese adults aged 35 to 74 years. Kidney Int 68(6):2837–2845. CrossRefPubMedGoogle Scholar
  3. 3.
    Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, Hostetter TH (2005) Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol 16(1):180–188. CrossRefPubMedGoogle Scholar
  4. 4.
    Hostetter TH (2004) Chronic kidney disease predicts cardiovascular disease. N Engl J Med 351(13):1344–1346. CrossRefPubMedGoogle Scholar
  5. 5.
    Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M (2016) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Revista espanola de cardiologia (English ed) 69(2):177. CrossRefGoogle Scholar
  6. 6.
    Archer S, Rich S (2000) Primary pulmonary hypertension: a vascular biology and translational research “Work in progress”. Circulation 102(22):2781–2791CrossRefPubMedGoogle Scholar
  7. 7.
    Martin KB, Klinger JR, Rounds SI (2006) Pulmonary arterial hypertension: new insights and new hope. Respirology 11(1):6–17. CrossRefPubMedGoogle Scholar
  8. 8.
    Yigla M, Nakhoul F, Sabag A, Tov N, Gorevich B, Abassi Z, Reisner SA (2003) Pulmonary hypertension in patients with end-stage renal disease. Chest 123(5):1577–1582CrossRefPubMedGoogle Scholar
  9. 9.
    Havlucu Y, Kursat S, Ekmekci C, Celik P, Serter S, Bayturan O, Dinc G (2007) Pulmonary hypertension in patients with chronic renal failure. Respiration 74(5):503–510CrossRefPubMedGoogle Scholar
  10. 10.
    Abdelwhab S, Elshinnawy S (2008) Pulmonary hypertension in chronic renal failure patients. Am J Nephrol 28(6):990–997CrossRefPubMedGoogle Scholar
  11. 11.
    Issa N, Krowka MJ, Griffin MD, Hickson LJ, Stegall MD, Cosio FG (2008) Pulmonary hypertension is associated with reduced patient survival after kidney transplantation. Transplantation 86(10):1384–1388CrossRefPubMedGoogle Scholar
  12. 12.
    Yigla M, Banderski R, Azzam ZS, Reisner SA, Nakhoul F (2008) Arterio-venous access in end-stage renal disease patients and pulmonary hypertension. Ther Adv Respir Dis 2(2):49–53CrossRefPubMedGoogle Scholar
  13. 13.
    Yigla M, Fruchter O, Aharonson D, Yanay N, Reisner SA, Lewin M, Nakhoul F (2009) Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Int 75(9):969–975CrossRefPubMedGoogle Scholar
  14. 14.
    Kiykim AA, Horoz M, Ozcan T, Yildiz I, Sari S, Genctoy G (2010) Pulmonary hypertension in hemodialysis patients without arteriovenous fistula: the effect of dialyzer composition. Ren Fail 32(10):1148–1152CrossRefPubMedGoogle Scholar
  15. 15.
    Zlotnick DM, Axelrod DA, Chobanian MC, Friedman S, Brown J, Catherwood E, Costa SP (2010) Non-invasive detection of pulmonary hypertension prior to renal transplantation is a predictor of increased risk for early graft dysfunction. Nephrol Dial Transpl 25(9):3090–3096CrossRefGoogle Scholar
  16. 16.
    Pabst S, Hammerstingl C, Hundt F, Gerhardt T, Grohe C, Nickenig G, Woitas R, Skowasch D (2012) Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: Results of the pepper-study. PLoS ONE 7(4):e35310CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Said K, Hassan M, Baligh E, Zayed B, Sorour K (2012) Ventricular function in patients with end-stage renal disease starting dialysis therapy: a tissue Doppler imaging study. Echocardiography 29(9):1054–1059CrossRefPubMedGoogle Scholar
  18. 18.
    Emara MM, Habeb MA, Alnahal AA, Elshazly TA, Alatawi FO, Masoud AS (2013) Prevalence of pulmonary hypertension in patients with chronic kidney disease on and without dialysis. Egypt J Chest Dis Tuberc 62(4):761–768CrossRefGoogle Scholar
  19. 19.
    Li Z, Liang X, Liu S, Ye Z, Chen Y, Wang W, Li R, Xu L, Feng Z, Shi W (2014) Pulmonary hypertension: Epidemiology in different CKD stages and its association with cardiovascular morbidity. PLoS ONE 9(12):e114392CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Yang QM, Bao XR (2014) Pulmonary hypertension in patients with stage 1-3 chronic kidney disease. Genet Mol Res 13(3):5695–5703CrossRefPubMedGoogle Scholar
  21. 21.
    Babua C, Kalyesubula R, Okello E, Kakande B, Sebatta E, Mungoma M, Mondo C (2015) Pattern and presentation of cardiac diseases among patients with chronic kidney disease attending a national referral hospital in Uganda: a cross sectional study. BMC Nephrol 16(1):126CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Suresh H, Arun BS, Moger V, Swamy M (2017) Cardiorenal syndrome type 4: a study of cardiovascular diseases in chronic kidney disease. Indian Heart J 69(1):11–16CrossRefGoogle Scholar
  23. 23.
    Selvaraj S, Shah SJ, Ommerborn MJ, Clark CR, Hall ME, Mentz RJ, Qazi S, Robbins JM, Skelton TN, Chen J, Gaziano JM, Djousse L (2017) Pulmonary hypertension is associated with a higher risk of heart failure hospitalization and mortality in patients with chronic kidney disease: the Jackson Heart Study. Circ Heart Fail. PubMedPubMedCentralGoogle Scholar
  24. 24.
    Reque J, Garcia-Prieto A, Linares T, Vega A, Abad S, Panizo N, Quiroga B, Boira EJC, Lopez-Gomez JM (2017) Pulmonary Hypertension is associated with mortality and cardiovascular events in chronic kidney disease patients. Am J Nephrol 45(2):107–114CrossRefPubMedGoogle Scholar
  25. 25.
    O’Leary JM, Assad TR, Xu M, Birdwell KA, Farber-Eger E, Wells QS, Hemnes AR, Brittain EL (2017) Pulmonary hypertension in patients with chronic kidney disease: invasive hemodynamic etiology and outcomes. Pulm Circ 7(3):674–683CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Navaneethan SD, Roy J, Tao K, Brecklin CS, Chen J, Deo R, Flack JM, Ojo AO, Plappert TJ, Raj DS, Saydain G, Sondheimer JH, Sood R, Steigerwalt SP, Townsend RR, Dweik RA, Rahman M (2016) Prevalence, predictors, and outcomes of pulmonary hypertension in CKD. J Am Soc Nephrol 27(3):877–886CrossRefPubMedGoogle Scholar
  27. 27.
    Genctoy G, Arikan S, Gedik O (2015) Secondary hyperparathyroidism is associated with pulmonary hypertension in older patients with chronic kidney disease and proteinuria. Int Urol Nephrol 47(2):353–358. CrossRefPubMedGoogle Scholar
  28. 28.
    Bolignano D, Lennartz S, Leonardis D, D’Arrigo G, Tripepi R, Emrich IE, Mallamaci F, Fliser D, Heine G, Zoccali C (2015) High estimated pulmonary artery systolic pressure predicts adverse cardiovascular outcomes in stage 2–4 chronic kidney disease. Kidney Int 88(1):130–136CrossRefPubMedGoogle Scholar
  29. 29.
    Bolignano D, Rastelli S, Agarwal R, Fliser D, Massy Z, Ortiz A, Wiecek A, Martinez-Castelao A, Covic A, Goldsmith D, Suleymanlar G, Lindholm B, Parati G, Sicari R, Gargani L, Mallamaci F, London G, Zoccali C (2013) Pulmonary hypertension in CKD. Am J Kidney Dis 61(4):612–622. CrossRefPubMedGoogle Scholar
  30. 30.
    Sise ME, Courtwright AM, Channick RN (2013) Pulmonary hypertension in patients with chronic and end-stage kidney disease. Kidney Int 84(4):682–692. CrossRefPubMedGoogle Scholar
  31. 31.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012. CrossRefPubMedGoogle Scholar
  32. 32.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg (London, England) 12(12):1495–1499. CrossRefGoogle Scholar
  33. 33.
    Lv TT, Wang P, Guan SY, Li HM, Li XM, Wang B, Pan HF (2017) Prevalence of pulmonary hypertension in systemic lupus erythematosus: a meta-analysis. Ir J Med Sci. Google Scholar
  34. 34.
    Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101CrossRefPubMedGoogle Scholar
  35. 35.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Yao Z, Wang C, Zhang Q, Ma S, Gui B, Duan C (2017) Prevalence of abdominal artery calcification in dialysis patients with end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol 49(11):2061–2069. CrossRefPubMedGoogle Scholar
  37. 37.
    Park M, Hsu CY, Li Y, Mishra RK, Keane M, Rosas SE, Dries D, Xie D, Chen J, He J, Anderson A, Go AS, Shlipak MG (2012) Associations between kidney function and subclinical cardiac abnormalities in CKD. J Am Soc Nephrol 23(10):1725–1734. CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Giaid A (1998) Nitric oxide and endothelin-1 in pulmonary hypertension. Chest 114(3 Suppl):208s–212sCrossRefPubMedGoogle Scholar
  39. 39.
    Jarava C, Marti V, Gurpegui ML, Merello JI, Rdez-Quesada B, Palma A (1993) Pulmonary calcification in chronic dialysis patients. Nephrol Dial Transpl 8(7):673–674Google Scholar
  40. 40.
    Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A, Gomez Sanchez MA, Krishna Kumar R, Landzberg M, Machado RF, Olschewski H, Robbins IM, Souza R (2013) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 62(25 Suppl):D34–D41. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Weifeng Shang
    • 1
  • Yuanyuan Li
    • 2
  • Yali Ren
    • 3
  • Wei Li
    • 1
  • HongLan Wei
    • 1
  • Junwu Dong
    • 1
  1. 1.Department of Nephrology and Rheumatology, The Forth Hospital of Wuhan Affiliated with Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China
  2. 2.Department of Respiratory Medicine, The Forth Hospital of Wuhan Affiliated with Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China
  3. 3.Department of Medical Affaires, Liyuan Hospital Affiliated to Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China

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