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.

Keywords:

• Predictors
• prevalence
• prognostic
• pulmonary hypertension
• chronic kidney disease
• meta-analysis

Acknowledgements

Not applicable.

Author contributions

Study conception and design, data acquisition: LC and GQ; data interpretation and statistical analysis: LC, and WL; manuscript writing: LC, ZP and HM; revision of the manuscript: LC, and LD.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the National Natural Science Foundation of China [Grant No. 82070046]