Title: Pulmonary Hypertension in Patients of Chronic Kidney Disease on Maintenance Hemodialysis: Study from a Tertiary Care Center in Central India

Biography:

Dr.Trishala Chhabra Khanna is presently working as Consultant Nephrologist at DNS Hospitals,a private hospital in Indore,(M.P.),India. She has done MBBS from Government MGM Medical College,Indore,(India).Then she pursued MD in Internal Medicine from Government NSCB Medical College,Jabalpur (India).She thereby pursued superspecialisation in the form of  DM in Nephrology from SAIMS,Indore (India).She also served in Covid Pandemic in Goverment MY Hospital in Indore,India.She is passionate about Nephrology and has special interest in Critical Care Nephrology and Kidney Transplantation.

Abstract

OBJECTIVE :1. To study the incidence of  pulmonary hypertension (PH) in chronic kidney disease (CKD) stage V patients on maintenance hemodialysis (HD) at our center.2. To compare clinical and metabolic variables among CKD patients with and without PH to search for possible etiologic factors. 3.Comparison of  PH in CKD patients at baseline and after 3 months of  sildenafil therapy.

 METHODS :  The study was conducted in the Department of  Nephrology, Sri Aurobindo Institute of  Medical Sciences, Indore, for a period of  1 year from December 2021 to November 2022. All CKD patients on maintenance HD at our center were included in the study. A pre-structured proforma was used to record patient data. Detailed clinical examination, 2DECHO, and Biochemical tests were done. All patients with mean pulmonary artery pressure (mPAP) > 25 mmHg on 2D echocardiography were considered to have PH and were started on sildenafil therapy 20 mg three times a day for 3 months. PH was classified as mild PH (mPAP > 25 up to 40 mmHg), moderate PH (mPAP > 40 mmHg to 60 mmHg), and severe PH (mPAP > 60 mmHg). Patients were then followed for 3 months to look for episodes of   dyspnea  and  emergency  admissions  and  reassessed  after  3  months  by  repeat  2D  echocardiography  to  find  improvement  in  PH.

 RESULT : A  total  of   102  patients were analyzed during the study period; among them, 40 patients (39.2%) had PH. Out of  them, 18 patients (45%) had mild PH, 14 patients (35%) had moderate PH, and 8 patients (20%) patients had severe PH. Average age of  our patients was 48.8 ± 9.4 years, the majority being men. On comparing the clinical features between patients with and without PH, none of  the clinical parameters had any statistically significant impact on PH. Also, none of  the laboratory parameters had statistical significance among PH and non-PH groups. Among the patients with PH, 25 patients (62.5%) had Arteriovenous (AV) fistula, 10 patients (25%) had temporary dialysis catheters,8 patients (20%) had jugular catheters, 2 patients (5%) had femoral catheters, and 5 (12.5%) patients had tunneled jugular catheters. Initially, 102 patients were enrolled in the study. Of  these, 40 (39.2%) had PH and 62 (60.7%) did not. Patients who had PH started sildenafil 20 mg three times a day. Of  these 40 patients, at 3 months, eight patients were lost to follow-up, and 32 patients with PH remained in the study. The mean PH at baseline was 47.8 ± 8.9 mmHg and at 3 months the mean PH was 44.4 ± 7.8 mmHg. mPAP at baseline and at 3 months was compared with the severity of  PH. After 3 months, there were 14 patients with mild PH, 11 patients with moderate PH, and 7 patients with severe PH. After treatment, five patients downgraded from mild to no PH, four patients from moderate to mild PH, and three patients from severe to moderate PH. Emergency admissions in each group of  PH declined after 3 months, and the result was statistically significant. Echocardiographic findings were compared in patients with PH and without PH, but the difference in patients on HD with PH and without PH was not statistically significant.

CONCLUSION :  PH is a significant problem in CKD patients on HD. This issue needs to be evaluated in a timely manner to avoid the risk of  morbidity and mortality. It is vital to treat them at the earliest to prevent life-threatening complications.