Document Type : Original Article(s)

Authors

1 Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran

Abstract

BACKGROUND: Pulmonary hypertension (PH) is a common finding i n c hronic k idney d isease (CKD)
and is associated with increased mortality and morbidity. The effect of kidney transplantation on PH is not
yet well evaluated. This study aimed to compare pulmonary artery pressure (PAP) before and after kidney
transplantation in CKD patients.
METHOD: This longitudinal study was conducted on 33 CKD patients who were candidates for kidney
transplantation in a tertiary hospital in Mashhad, Iran. Pulmonary artery pressure and ejection fraction (EF)
were assessed using trans-thoracic echocardiography (TTE). Demographic and clinical findings, including
age, gender, and body mass index (BMI), as well as laboratory assessments, including hemoglobin, serum
calcium and phosphorus level, and parathyroid hormone, were recorded before transplantation. TTE
assessment was repeated one year after transplantation.
RESULTS: Mean age of the study patients (17 males and 16 females) was 30.42 ± 9.71 years. The majority
of patients (85%) received hemodialysis before transplantation. Compared to before transplantation,
PAP significantly decreased (from 33.67 ± 6.78 to 26.06 ± 5.78 mmHg, P<0.001) and EF increased (from
52.85 ± 7.12 to 57.03 ± 4.08, P=0.003) one year after transplantation. A significant positive correlation was
found between PAP difference and EF before transplantation.
CONCLUSIONS: The findings o f t his s tudy s howed t hat k idney t ransplantation w as c orrelated with
improved PAP and EF one year after transplantation and EF before kidney transplantation was correlated
with PAP changes.

Keywords

  1. Bolignano D, Rastelli S, Agarwal R, Fliser D, Massy Z, Ortiz A, Wiecek A, Martinez-Castelao A, Covic A, Goldsmith D, Suleymanlar G. Pulmonary hypertension in CKD. American journal of kidney diseases. 2013; 61(4): 612-22.
  2. Di Lullo L, Floccari F, Rivera R, Barbera V, Granata A, Otranto G, Mudoni A, Malaguti M, Santoboni A, Ronco C. Pulmonary hypertension and right heart failure in chronic kidney disease: new challenge for 21st-century cardionephrologists. Cardiorenal medicine. 2013; 3(2): 96-103.
  3. Li Z, Liang X, Liu S, Ye Z, Chen Y, Wang W, Li R, Xu L, Feng Z, Shi W. Pulmonary hypertension: epidemiology in different CKD stages and its association with cardiovascular morbidity. PloS one. 2014; 9(12): e114392.
  4. Thenappan T. Pulmonary hypertension in chronic kidney disease: a hemodynamic characterization. Pulmonary Circulation. 2017; 7(3): 567-8.
  5. Shang W, Li Y, Ren Y, Li W, Wei H, Dong J. Prevalence of pulmonary hypertension in patients with chronic kidney disease without dialysis: a meta-analysis. International urology and nephrology. 2018; 50(8): 1497-504.
  6. Schoenberg NC, Argula RG, Klings ES, Wilson KC, Farber HW. Prevalence and mortality of pulmonary hypertension in ESRD: a systematic review and meta-analysis. Lung. 2020; 198(3): 535-45.
  7. Tang M, Batty JA, Lin C, Fan X, Chan KE, Kalim S. Pulmonary hypertension, mortality, and cardiovascular disease in CKD and ESRD patients: a systematic review and meta-analysis. American journal of kidney diseases. 2018; 72(1): 75-83.
  8. Rabih F, Holden RL, Vasanth P, Pastan SO, Fisher MR, Trammell AW. Effect of pulmonary hypertension on 5‐year outcome of kidney transplantation. Pulmonary circulation. 2022; 12(1): e12010.
  9. Suresh H, Arun BS, Moger V, Vijayalaxmi PB, Mohan KM. A prospective study of pulmonary hypertension in patients with chronic kidney disease: a new and pernicious complication. Indian Journal of Nephrology. 2018; 28(2): 127.
  10. Hawwa N, Shrestha K, Hammadah M, Yeo PS, Fatica R, Tang WW. Reverse remodeling and prognosis following kidney transplantation in contemporary patients with cardiac dysfunction. Journal of the American College of Cardiology. 2015; 66(16): 1779-87.
  11. Alhamad EH, Al-Ghonaim M, Alfaleh HF, Cal JP, Said N. Pulmonary hypertension in end-stage renal disease and post renal transplantation patients. Journal of thoracic disease. 2014; 6(6): 606.
  12. Sise ME, Courtwright AM, Channick RN. Pulmonary hypertension in patients with chronic and end-stage kidney disease. Kidney international. 2013; 84(4): 682-92.
  13. Hawwa N, Shrestha K, Hammadah M, Yeo PS, Fatica R, Tang WW. Reverse remodeling and prognosis following kidney transplantation in contemporary patients with cardiac dysfunction. Journal of the American College of Cardiology. 2015; 66(16): 1779-87.
  14. Reddy YN, Lunawat D, Abraham G, Matthew M, Mullasari A, Nagarajan P, Reddy YN. Progressive pulmonary hypertension: another criterion for expeditious renal transplantation. Saudi Journal of Kidney Diseases and Transplantation. 2013; 24(5): 925.
  15. Zhang Q, Wang L, Zeng H, Lv Y, Huang Y. Epidemiology and risk factors in CKD patients with pulmonary hypertension: a retrospective study. BMC nephrology. 2018; 19(1): 1-8.
  16. Reddy YN, Lunawat D, Abraham G, Matthew M, Mullasari A, Nagarajan P, Reddy YN. Progressive pulmonary hypertension: another criterion for expeditious renal transplantation. Saudi Journal of Kidney Diseases and Transplantation. 2013 ;24(5):
  17. Sadat B, Tirunagari D, Karthikeyan V, Patel A, Van Harn M, Saleem MM, Ananthasubramaniam K. Clinical impact of pre-kidney transplant pulmonary hypertension on post-transplant outcomes. The international journal of cardiovascular imaging. 2021; 37(6): 1979-86.