Objective: Due to limited study in our region on pulmonary hypertension in chronic kidney disease patients, we planned a study to detect the prevalence of Pulmonary hypertension in patients with chronic kidney disease. An additional objective was to study an association between pulmonary hypertension and CKD stage if any. Methods: Hospital based cross-sectional study was conducted on 108 diagnosed cases of CKD (according to different stages based on GFR) and age more than 18 years. All data collected and analyzed by SPSS software. Co-relation co-efficient was used to find out correlation. Results: Prevalence of pulmonary hypertension in CKD patients was 15.74%. 47.06% patients were mild, 41.18% patients were moderate and 11.11% patients were in severe pulmonary hypertension. The association between pulmonary hypertension and CKD stage was found statically insignificant. In linear regression between age, CKD stage &amp; duration and PAH was found statistically insignificant. Conclusion: Prevalence of pulmonary hypertension in CKD patients was 15.74%. Pulmonary hypertension had positive correlation with stage of CKD, duration of CKD and age of patients

Dr. Pooja Yadav

Dr. R. P. Agrawal

Dr. Swati Vyas

Objective: We organized a study to determine the prevalence of pulmonary hypertension (PHT) in individuals with chronic renal disease, because there has not been much research on this topic in our area. Studying any relationships, if any, between PHT and chronic kidney disease (CKD) stage was another goal.
Methods: A hospital-based cross-sectional study of 108 CKD cases was carried out (according to various phases based on glomerular filtration rate) and included participants over the age of 18. SPSS software was used to collect and analyze all data. Correlation was determined using the corelation coefficient.
Results: About 15.74% of people with CKD had PHT. Patients’ PHT was mild in 47.06% of cases, moderate in 41.18% of cases, and severe in 11.11% of cases. The correlation between the stage of CKD and PHT was determined to be statistically negligible. Age, CKD stage and duration, and PAH were revealed to be statistically unimportant in linear regression.
Conclusion: About 15.74% of CKD patients had PHT, according to the study. The age of the patients, the length of the CKD, and the stage of the CKD were positively correlated with PHT

VYAS, SWATI

YADAV, POOJA

RP, AGRAWAL

Innovare Academic Sciences: E-Journals

Vol 15, Issue 9, 2022Online - 2455-3891 Print - 0974-2441PREVALENCE OF PULMONARY HYPERTENSION IN PATIENTS OF CHRONIC KIDNEY DISEASE IN WESTERN RAJASTHAN: A CROSS-SECTIONAL STUDYSWATI VYAS1*, POOJA YADAV2, AGRAWAL RP21Department of General Medicine, Government Medical College, Kota, Rajasthan, India. 2Department of General Medicine, Sardar Patel Medical College, Bikaner, Rajasthan, India. Email: Vyasdrswati@gmail.comObjective: We organized a study to determine the prevalence of pulmonary hypertension (PHT) in individuals with chronic renal disease, because there has not been much research on this topic in our area. Studying any relationships, if any, between PHT and chronic kidney disease (CKD) stage was another goal.Methods: A hospital-based cross-sectional study of 108 CKD cases was carried out (according to various phases based on glomerular filtration rate) and included participants over the age of 18. SPSS software was used to collect and analyze all data. Correlation was determined using the corelation coefficient.Results: About 15.74% of people with CKD had PHT. Patients’ PHT was mild in 47.06% of cases, moderate in 41.18% of cases, and severe in 11.11% of cases. The correlation between the stage of CKD and PHT was determined to be statistically negligible. Age, CKD stage and duration, and PAH were revealed to be statistically unimportant in linear regression.Conclusion: About 15.74% of CKD patients had PHT, according to the study. The age of the patients, the length of the CKD, and the stage of the CKD were positively correlated with PHT.Keywords: Chronic kidney disease, Pulmonary hypertension, Stage.INTRODUCTIONA variety of pathophysiologic mechanisms connected to poor kidney function and a steady decline in glomerular filtration rate (GFR) make up chronic kidney disease (CKD). The estimated GFR and the level of albuminuria are used to stratify the various stages of CKD. The recommendations describe CKD as kidney structural and function problems that have persisted for at least 3 months [1].Peak systolic pulmonary artery pressure typically ranges between 18 and 25 mm Hg. With age, pulmonary artery pressure and pulmonary vascular resistance rise. This could be caused by increased wall thickness in the pulmonary arteries or decreased compliance of the pulmonary artery as a result of intimal fibrosis. The majority of CKD patients have high blood pressure, diastolic dysfunction, an AV fistula, anemia, uremia, volume overload with interstitial pulmonary edema, and a high cardiac output condition, all of which can result in elevated pulmonary vascular pressure [2].Pulmonary hypertension (PHT) is a result of hemodialysis-specific factors such exposure to the dialysis membrane and AV fistula. Patients with uremic patients receiving hemodialysis through AV access show reduced nitric oxide generation. The inability of the pulmonary circulation to maintain the elevation of cardiac output caused by AV access due to endothelial dysfunction and prolonged endothelin elevation results in PHT [3]. Due to limited study in our region on PHT in CKD patients, we planned a study to detect the prevalence of PHT in patients with CKD. An additional objective was to study an association between PHT and CKD stage if any.METHODSStudy designThe study was hospital-based cross-sectional study.Study durationThe study duration was 12 months – August 1, 2019–July 30, 2020.Study placeThis was Department of medicine, S. P. Medical College and P.B.M Hospital, BikanerSample sizeThe sample size was estimated using the proportion of PHT in CKD patients from the literature as 50%. Using the formula,α−−=21 22(1 )Z p pSample sizedHere, α− 21 2Z = Is standard normal variate (at 5% Type 1 error [p<0.05], it is 1.96; at 1% Type 1 error [p<0.01], it is 2.58). As in majority of studies, p<0.05 was considered statistically significant, and hence, 1.96 is used in the formula.p=Expected proportion in population based on the previous studies or pilot studiesd=Absolute error or precision – has to be decided by researcher.p=50; q=50; d=10%.A sample size of 98 CKD patients with a 95% confidence level was required for the investigation using the aforementioned values. The study used a sample size of 98+9.8 108 people after accounting for a 10% non-response rate.Sampling methodThis was random sampling.Inclusion criteriaThe following criteria were included in the study:© 2022 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) DOI: http://dx.doi.org/10.22159/ajpcr.2022v15i9.45454. Journal homepage: https://innovareacademics.in/journals/index.php/ajpcrResearch ArticleReceived: 28 May 2022, Revised and Accepted: 10 June 2022ABSTRACT203Asian J Pharm Clin Res, Vol 15, Issue 9, 2022, 202-204 Vyas et al.1. Diagnosed cases of CKD (according to different stages based on GFR).2.	 Age	≥18	years.Staging of CKD by GFR and albuminuria (KDIGO 2012)Stage 1 kidney damage with normal or increased GFR (>90 ml/min/1.73 m2)Stage 2 mild reduction in GFR (60–89 ml/min/1.73 m2)Stage 3a moderate reduction in GFR(45–59 ml/min/1.73 m2)Stage 3b moderate reduction in GFR (30–44 ml/min/1.73 m2)Stage 4 severe reduction in GFR (15–29 ml/min/1.73 m2)Stage 5 kidney failure (GFR < 15 ml/min/1.73 m2).On basis of ALBUMINURIAA1 Albuminuria <30 mg/g or <3 mg/mmol.A2 Albuminuria 30–300 mg/g or 3–30 mg/mmol.A3 Albuminuria >300 mg/g or >30 mg/mmol.Exclusion criteriaThe following criteria were excluded from the study:1. Those not willing to participate in the study2. Age <18 years3. Valvular heart diseases4. Congenital heart diseases5. Pulmonary obstructive and restrictive diseases6. HIV-infected patients7. Chronic liver disease8. Connective tissue diseases9. Hypothyroidism and hyperthyroidism.Ethical approvalThe study begun after obtaining ethical approval from the ethical committee of the medical college.Data analysisFrequencies, numbers, proportions, and measures of central tendency were utilized to examine the data using Microsoft Excel and the statistical program SPSS. For qualitative data, the Chi-square test was utilized, and for quantitative data, the t-test. Correlation was determined using the corelation coefficient.RESULTSOut of 108 subjects in our study, the majority (53.70%) were in the 46–60 year age range, followed by 28.70% of subjects under 45 and just 17.60% of subjects over 60. Thirty-two participants (29.63%) and 76 (70.67%) were male and female, respectively. Diabetes and hypertension were present in 41.67 and 55.56% of patients, respectively. About 25.00% of subjects with CKD had it for 5–10 years, while 66.67% had it for <5 years.In our study, out of 108 subjects, the highest percentage (43.52%) had CKD Stage 5, while the lowest percentage (26.70%) had CKD Stage 4.Prevalence of pulmonary hypertension in CKD patients was 15.74%.Patients with mild PHT made up 47.6% of the population, those with moderate hypertension made up 41.8%, and those with severe hypertension made up 11.1%.01020304050CKD stage3 CKD stage4 CKD stage 5No of casesAssociation between pulmonary hypertension and CKD stagePulmonaryhypetension PresentPulmonaryhypetension AbsentThe association between PHT and CKD stage was found statically insignificant.In linear regression between age, CKD stage and duration and PAH were found statistically insignificant.DISCUSSIONSince India is the world’s diabetes capital, chronic renal disease is also on the rise. Cardiovascular disease and other consequences are more likely in those with CKD. A significant factor in CKD patients’ mortality is cardiac disease. Higher cardiac output and pulmonary blood flow both contribute to the increased prevalence of PHT. Due to changes in metabolism and hormones, CKD patients also run the risk of developing PHT. As a result, the pulmonary arteries become more constricted, increasing pulmonary resistance.Regardless of its genesis, PHT, a condition marked by raised pulmonary artery pressure, is a progressive problem worsening heart, lung, or systemic diseases and is associated with increased morbidity and death [4]. PHT has recently been discovered to be a potent independent predictor of morbidity and mortality in hemodialysis patients [5].PHT patients had a death rate of 30.4% compared to 8.5% among patients without PH (p 0.03) in an observational study of 58 hemodialysis patients with a mean follow-up of 30 months [6]. With 1 year, 3 year, and 5 year, survival rates of 78.6% compared 96.5%, 42.9% versus 78.8%, and 25.2% versus 66.4%, respectively (p<0.0001). CKD stage Number of subject Percentage3 30 27.784 31 28.705 47 43.52Total 108 100.00Pulmonary hypertension Number of subject PercentagePresent 17 15.74Absent 91 84.16Total 108 100.00Grading Number of subject PercentageMild 8 47.06Moderate 7 41.18Severe 2 11.11Total 17 100.00Variable Corelation coefficient p‑valueAge 0.92 0.01CKD duration 0.87 0.01CKD Stage 0.91 0.01Table 1: Distribution of study subjects according to stage of CKDTable 2: Prevalence of pulmonary hypertension in CKD subjectsTable 3: Distribution of study subjects according to grade of pulmonary hypertensionTable 4: Distribution of PAH according to multivariate linear regression of different variableIncreased  cardiac  output  and  elevated  pulmonary  artery pressure  are  caused  by  the  presence  of  an  AV  fistula,  reduced hemoglobin,  and  volume  overload.  Determining  the  prevalence  of PHT  in  CKD  patients  is  the  purpose  of  our  investigation,  thus. Higher cardiac output and pulmonary blood flow both contribute to  the  increased  prevalence  of  PHT.  In  our  study,  17  (or 15.74%)  of  the  108  CKD  patients  tested  developed  PHT  as determined by 2D Echo.204Asian J Pharm Clin Res, Vol 15, Issue 9, 2022, 202-204 Vyas et al.Yigla et al. [7], samples of CKD patients, showed considerably shorter survival than those without PHT. The prevalence of PHT in CKD patients has been the subject of very few Indian studies. PHT has been identified as a common condition in ESRD patients and is thought to exist independently of the prevalence of cardiovascular illness.In our study, 15.74% of the patients with CKD had PHT. The prevalence of PH was observed to range between 26.74% by Tarras et al. [8] to 68.6% by Moniruzzaman et al. [9].In a different Indian study, Patel et al. [10] examined 100 patients (69 men and 31 women) who were receiving hemodialysis, continuous ambulatory peritoneal dialysis, or conservative treatment (CAPD). The prevalence of PH in this cohort was 41%, with the hemodialysis group having the greatest frequency (33%). The differences in the ethnic composition of the population studied as well as in the study group, regarding stage of CKD, mode of dialysis (HD vs. PD), comorbid conditions such as COPD/CHF, and inclusion criteria, can be used to explain the variation in the prevalence of PH among CKD patients in different studies [11,12]. Even though these studies looked at different factors and are not really comparable, the majority of them found that PHT was highly prevalent among CKD patients.In our investigation, age had no bearing on the occurrence of PH. This outcome was comparable to that of the research by Mazdeh et al. [13] (p=0.58) (p=0.37). Tarras et al., Age and PHT, did not correlate, according to Patel et al. [10] (p=0.402). Due to the small number of study participants, there was a positive link between CKD stage and PH in the current investigation, although it was not statistically significant. All of the patients in our study group were in stages III, IV, or V because we are a tertiary referral center, and most of our patients are late referrals.The alarming finding by Yang et al. [14] that PH exists and may be prominent before the decline in GFR to 60 ml/min/1.73 m2 was reached which was the PH prevalence of 23.76% (24/101) in Stage II and 48.15% (13/27) in the GFR 60 mL/min/1.73 m2 group. In a study by Li et al. [15], severe PH was found at CKD patients in Stage – V along with rising PH prevalence and cardiovascular morbidity as renal disease progressed.Poor understanding persists of the precise mechanisms underlying PH in advanced CKD. Left ventricular dysfunctions and CKD-related risk factors, such as volume overload, AVF, sleep apnea, contact with dialysis membranes, endothelial dysfunction, vascular calcification and stiffening, and severe anemia, may cause or exacerbate PH [9]. The World Symposium of PH classified ESRD-related PH for the 1st time as the 5th subtype of PH (PH with unknown multifactorial causes) (WSPH) [11]. PH in CKD without major cardiac and pulmonary illnesses is included in this group. Chest radiography, pulmonary function tests, CT scans, and ventilation/perfusion scans are frequently used to rule out these concomitant disorders, which were discovered in 40%–70% of patients in most cohorts.After this study, we discovered a positive correlation between PHT in CKD patients, which increase with stage and duration of CKD. By detecting it in its early stages by a non-invasive method like 2 D Echo, we can treat it early, thereby reducing related mortality and morbidity and producing a better patient outcome.CONCLUSIONAbout 15.74% of people with CKD had PHT. The age of the patients, the length of the CKD, and the stage of the CKD were positively correlated with PHT.Limitations of the study1. There is a tiny sample size.2. Patients on peritoneal dialysis and those with CKD Stages I and II were not included in the study.3. Rather than using the gold standard of right heart catheterization, the diagnosis of PH was made using indirect echocardiographic estimates of PA systolic pressure.4.	 Coronary	angiography	and	a	stress	test	did	not	rule	out	significant	coronary artery disease.5. There is no ongoing patient monitoring.ACKNOWLEDGMENTWe owe a debt of gratitude to S. P. Medical College for its encouragement and assistance during the course of the research.AUTHORS’ CONTRIBUTIONSAll the authors have contributed equally.CONFLICTS OF INTERESTThe authors declare no conflicts of interest.AUTHOR’S FUNDINGThe authors, hereby, state that they did not get any financial assistance for their research, writing, or publication of this paper.REFERENCES1. Locatelli F, Marcelli D, Conte F, D’Amico M, Del Vecchio L, Limido A, et al. Cardiovascular disease in chronic renal failure: The challenge continues. Registro lombardo dialisi e trapianto Nephrol Dial Transplant 2000;5:69-80. doi: 10.1093/ndt/15.suppl_5.69, PMID 11073278.2. Pastan S, Bailey J. Dialysis therapy. N Engl J Med 1998;338:1428-37. doi: 10.1056/NEJM199805143382006.3. Barak M, Katz Y. Microbubbles: Pathophysiology and clinical implications. Chest 2005;128:2918-32. doi: 10.1378/chest.128.4.2918, PMID 16236969.4. Humbert M, Sitbon O, Chaouat A, Bertocchi M, Habib G, Gressin V, et al. Pulmonary arterial hypertension in France: Results from a national registry. Am J Respir Crit Care Med 2006;173:1023-30. doi: 10.1164/rccm.200510-1668OC, PMID 16456139.5. Hadengue A, Benhayoun MK, Lebrec D, Benhamou JP. Pulmonary hypertension complicating portal hypertension: Prevalence and relation tosplanchnic hemodynamics. Gastroenterology 1991;100:520-8. doi: 10.1016/0016-5085(91)90225-a, PMID 1985048.6. Krowka MJ, Swanson KL, Frantz RP, McGoon MD, Wiesner RH. Portopulmonary hypertension: Results from a 10-year screening algorithm. Hepatology 2006;44:1502-10. doi: 10.1002/hep.21431, PMID 17133488.7. Yigla M, Fruchter O, Aharonson D, Yanay N, Reisner SA, Lewin M, et al. Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Int 2009;75:969-75. doi: 10.1038/ki.2009.10, PMID 19212417.8. Tarrass F, Benjelloun M, Hachim K, Benghanem MG, Ramdani B. Pulmonary hypertension in patients with end-stage renal disease. Indian J Nephrol 2005;15:223-6.9. Moniruzzaman M, Islam MN, Alam MB, Alam AM, Khan MM, Ali Z, et al. Pulmonary hypertension in hemodialysis patients. Cardiovasc J 2014;4:148-52. doi: 10.3329/cardio.v4i2.10459.10. Abraham G, Pratap B, Ramalakshmi R, Mathew M, Jeevan J, Muralidharan T, et al. Clinical and biochemical parameters in chronic kidney disease with pulmonary hypertension. Indian J Nephrol 2007;17:4-6. doi: 10.4103/0971-4065.35012.11. Gokul R. Replacement therapy by dialysis. In: Weatherall DJ, Ledingham JG, Warrell DA, editors. Oxford Textbook of Medicine. 3rd ed. Oxford: Oxford University Press; 1996. p. 3306-10.12. Yigla M, Dabbah S, Azzam ZS, Rubin AH, Reisner SA. Background diseases in 671 patients with moderate to severe pulmonary hypertension. Isr Med Assoc J 2000;2:684-9. PMID 11062769.13. Mahdavi-Mazdeh M, Alijavad-Mousavi S, Yahyazadeh H, Azadi M, Yoosefnejad H, Ataiipoor Y. Pulmonary hypertension in hemodialysis patients. Saudi J Kidney Dis Transpl 2008;19:189-93. PMID 18310865.14. van Guldener C, Lambert J, Janssen MJ, Donker AJ, Stehouwer CD. Endothelium-dependent vasodilatation and distensibility of large arteries in chronic haemodialysis patients. Nephrol Dial Transplant 1997;2:14-8 PMID 9269693.15. Li Z, Liang X, Liu S, Ye Z, Chen Y, Wang W, et al. Pulmonary hypertension: Epidemiology in different CKD stages and its association with cardiovascular morbidity. PLoS One 2014;9:e114392. doi: 10.1371/journal.pone.0114392, PMID 25525807.

English

PREVALENCE OF PULMONARY HYPERTENSION IN PATIENTS OF CHRONIC KIDNEY DISEASE IN WESTERN RAJASTHAN: A CROSS-SECTIONAL STUDY

PREVALENCE OF PULMONARY HYPERTENSION IN PATIENTS OF CHRONIC KIDNEY DISEASE IN WESTERN RAJASTHAN: A CROSS SECTIONAL STUDY: PULMONARY HYPERTENSION IN PATIENTS OF CHRONIC KIDNEY DISEASE

PREVALENCE OF PULMONARY HYPERTENSION IN PATIENTS OF CHRONIC KIDNEY DISEASE IN WESTERN RAJASTHAN: A CROSS SECTIONAL STUDY: PULMONARY HYPERTENSION IN PATIENTS OF CHRONIC KIDNEY DISEASE

Abstract

Similar works

Full text

Available Versions

Innovare Academic Sciences: E-Journals