Development of renal function during staged balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension

Abstract

Balloon pulmonary angioplasty (BPA), for chronic thromboembolic pulmonary hypertension, improves pulmonary and systemic hemodynamics. The kidney might benefit from this effect. However, staged BPA therapy comes along with repetitive administration of contrast agent. This study examined the overall effect of BPA therapy on renal function. This study included consecutive patients who underwent BPA treatment and completed a 6-month follow-up between March 2014 and March 2017. Biomarker-based evaluation of renal function was performed at baseline, consecutively prior to and after each BPA and at 6-month follow-up. The 51 patients underwent an average of 5 (±2) BPA sessions. In this course, patients received 133 (±48; 21–300) mL of contrast agent per session and 691 (±24; 240–1410) mL during the whole sequence. Acute kidney injury occurred after 6 (2.3%) procedures. The creatinine [80.1 (IQR 67.8–96.8) µmol/L vs. 77.4 (IQR 66.9–91.5) µmol/L, p = .02] and urea level [13.7 (IQR10.7–16.6) mmol/L vs. 12.5 (IQR 10.0–15.5) mmol/L, p = .02] decreased from baseline to the 6-month follow-up. The estimated glomerular filtration rate (eGFR) [79 (IQR 59–94) mL/min/m² vs. 79.6 (IQR 67.1–95.0) mL/min/m², p = .11] did not change. The Chronic kidney disease (CKD) stages at baseline were: G1:15; G2:23; G3a:10; G3b:2; G4:1; G5:0. Among patients with a CKD-stage ≥2, analysis revealed an increase of eGFR, decrease of creatinine and urea from baseline to 6-month follow-up. Among those patients, the baseline-CKD-stage improved in 14 (41.2%) patients. BPA therapy improves pulmonary and systemic hemodynamics, with positive effects on renal function. Repetitive administration of contrast agent seems not to be harmful regarding renal function.

Keywords:

• Cardiology
• kidney disease
• balloon pulmonary angioplasty
• chronic thromboembolic pulmonary hypertension
• kidney function
• troponins and cardiac biomarkers

Disclosure statement

The study BioCTEPH is part of the Kerckhoff Biomarker Registry (Bioreg) of the Kerckhoff Heart Research Institute (KHFI). BioReg is financially supported by the KHFI and the German Center for Cardiovascular Research (DZHK). The sponsor had no influence on the study design, statistical analyses or draft of the manuscript. CBW received consultant honoraria and/or speaker fees from Actelion, Bayer AG, MSD, Pfizer and BTG; MH received lecture honoraria from Daiichi-Sankyo and Pfizer; TK received speaker fees from Abbott; SG received speaker fees from Actelion, Bayer, GSK and Pfizer; AR received lecture honoraria from Astra Zeneca, Boehringer Ingelheim and Pfizer-Bristol-Myers Squibb; CWH received lecture or consulting honoraria from Astra Zeneca, Bayer, Boehringer Ingelheim, GSK, Daiichi-Sankyo and Pfizer-Bristol-Myers Squibb; EM received lecture or consulting honoraria from Actelion, Bayer, MSD, GSK, Pfizer and MSD; CL received lecture or consulting honoraria from Abbott, Astra Zeneca, Bayer, Berlin Chemie, Boehringer Ingelheim, Daiichi-Sankyo and Pfizer-Bristol-Myers Squibb. AJR received speaker fees from Servier, St. Jude Medical and Actelion, honoraria from Novartis and traveling support by Orion Pharma and Actelion. SDK, JSW, RA, DB, MH, AB, and FCR have nothing to declare.

Data availability statement

The raw data set, underlying this work is part of the Kerckhoff Biomarker Register and is locally available at the study site. Researchers and research groups from other institutions may access the data as partner within scientific research projects after proving legitimate scientific interest.