dc.description.abstract |
Background:Pulmonary hypertension is defined as systolic pulmonary artery pressure
(SPAP) > 35 mmHg at rest as estimated by Doppler echocardiographywhile Chronic Kidney
Disease (CKD) isthe presence of kidney damage or decreased kidney function for three or more
months, with eGFR<60mls/min irrespective of the cause. The prevalence of pulmonary
hypertension (PHTN) is much higher among patients on hemodialysis in studies done in Non African population and has been associated with a worse outcome. However, theextent of PHTN
has not been established in Kenyan patients withCKD on and without hemodialysis.
Objective:To determine the prevalence of pulmonary hypertension among CKD patients with
and without dialysis and to compare their clinical, hemodynamic and metabolic variablesat the
Moi Teaching and Referral Hospital (MTRH).
Methods: This cross-sectional hospital based study was conducted among adult patients with
Chronic Kidney Disease with or without dialysis in the renal and adult medical wards in MTRH,
Eldoret, Kenya.Pulmonary hypertension was defined as systolic pulmonary artery pressure
(SPAP) > 35 mmHg at rest as estimated by Doppler echocardiography and CKD as the presence
of kidney damage or decreased kidney function for three or more months with eGFR<60mls/min
irrespective of the cause.All patients who met the inclusion criteria were enrolled by prospective
consecutive sampling. Demography(age, gender), clinical (history and physical examination),
transthoracic Doppler echocardiography and laboratory (hemoglobin,hematocrit, BUN,
creatinine, potassium, phosphate and calcium levels, albumin, AST and ALT levels, HIV test and
RBS) were done. Data were collected using a structured interviewer administered questionnaire,
keyed into Microsoft Excel®
database and analyzed using STATA version 13
®
. Descriptive
statistics were summarized in tables and graphs and correlations were done using Pearson’s Chi
Square test.
Results: Among the 132 participants included in the final analysis, 82(62%) were male, median
age 47 years (IQR 31-59).Only 8% and 2% of the participants reported current history of alcohol
use and smoking respectively.Majority (82%) of the participants were hypertensive with a
median blood pressure of 150/90 mmHg (IQR 131/75-168/100). An estimated 81% of the
participants were on antihypertensives. An estimated 28% of the participants were diabetic, with
approximately 15% and 11 % of them being on oral hypoglycemics and insulin respectively.
Majority of the participants (78%) were on dialysis, with most (71%) having only one session of
dialysis per week. The most common venous access site was subclavian/internal jugular catheter
(87%), compared with arteriovenous fistula (11%) and tunneled catheter (2%)
respectively.Overall 70/132 participants (53%) had pulmonary hypertension. The prevalence of
pulmonary hypertension was higher among participants on dialysis 63/100 (63%) compared to
those not on dialysis 7/32 (22%). Patients on dialysis had higher odds of having pulmonary
hypertension (OR 5.9; 95%CI 2.4-15.2; p 0.0001) compared with patients not on dialysis.All
other factors assessed (such as gender, age, weight, hemoglobin, hematocrit, calcium and
potassium) were not significantly associated with pulmonary hypertension.
Conclusion:The prevalence of pulmonary hypertension in CKD patients is high at MTRH and it
is higher in those on dialysis compared to those not on dialysis.
Recommendations:Due to the high prevalence of PHTN in CKD patients, routine screening is
recommended for early detection and management. Large prospective studies using right heart
catheterization are needed to establish the true prevalence of pulmonary hypertension in CKD. |
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