Predictors, prevalence and prognostic role of pulmonary hypertension in patients with chronic kidney disease: a systematic review and meta-analysis.

ABSTRACT

BACKGROUND: To estimate the predictors, prevalence and prognostic role of pulmonary hypertension (PH) in patients with chronic kidney disease (CKD) using meta-analysis. METHODS: The PubMed, EmBase, and the Cochrane library were systematically searched for eligible studies from inception till May 2024. All of pooled analyses were performed using the random-effects model. RESULTS: Fifty observational studies involving 17,558 CKD patients were selected. The prevalence of PH in CKD patients was 38% (95% confidence interval [CI] 33%-43%), and the prevalence according to CKD status were 31% (95% CI 20%-42%) for CKD (I-V), 39% (95% CI 25%-54%) for end stage kidney disease (ESKD) (predialysis), 42% (95% CI 35%-50%) for ESKD (hemodialysis), and 26% (95% CI 19%-34%) for renal transplant. We noted the risk factors for PH in CKD included Black individuals (relative risk [RR] 1.39; 95% CI 1.18-1.63; p < 0.001), chronic obstructive pulmonary disease (RR 1.48; 95% CI 1.21-1.82; p < 0.001), cardiovascular disease history (RR 1.62; 95% CI 1.05-2.51; p = 0.030), longer dialysis (RR 1.70; 95% CI 1.18-2.46; p = 0.005), diastolic dysfunction (RR 1.88; 95% CI 1.38-2.55; p < 0.001), systolic dysfunction (RR 3.75; 95% CI 2.88-4.87; p < 0.001), and grade 5 CKD (RR 5.64; 95% CI 3.18-9.98; p < 0.001). Moreover, PH in CKD patients is also associated with poor prognosis, including all-cause mortality, major cardiovascular events, and cardiac death. CONCLUSION: This study systematically identified risk factors for PH in CKD patients, and PH were associated with poor prognosis. Therefore, patients with high prevalence of PH should be identified for treatment.