Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension?

BMC Nephrology

Thais Thomaz Queluz²  Roberto Jorge da Silva Franco¹  Silméia Garcia Zannati-Bazan³  Beatriz Bojikian Matsubara³  Jacqueline Teixeira Caramori¹  Pasqual Barretti¹  Lidiane Silva Rodrigues-Telini¹  Ana Claudia Kochi¹  Luis Cuadrado Martin¹  Hugo Hyung Bok Yoo² 

[1]Division of Nephrology, State University of São Paulo - UNESP, Botucatu School of Medicine, Botucatu, SP, Brazil

[2]Division of Pulmonology, State University of São Paulo - UNESP, Botucatu School of Medicine, Botucatu, SP, Brazil

[3]Division of Cardiology, State University of São Paulo - UNESP, Botucatu School of Medicine, Botucatu, SP, Brazil

关键词: Prognostic;    Pulmonary hypertension;    Hemodialysis;    End-stage renal disease;   

Others  :  1083133
DOI  :  10.1186/1471-2369-13-80

 received in 2011-11-21, accepted in 2012-07-31,  发布年份 2012

【 摘 要 】

Background

The pathogenesis of pulmonary hypertension (PH) in hemodialysis is still unclear. The aim of this study was to identify the risk factors associated with the presence of PH in chronic hemodialysis patients and to verify whether these factors might explain the highest mortality among them.

Methods

We conducted a retrospective study of hemodialysis patients who started treatment from August 2001 to October 2007 and were followed up until April 2011 in a Brazilian referral medical school. According to the results of echocardiography examination, patients were allocated in two groups: those with PH and those without PH. Clinical parameters, site and type of vascular access, bioimpedance, and laboratorial findings were compared between the groups and a logistic regression model was elaborated. Actuarial survival curves were constructed and hazard risk to death was evaluated by Cox regression analysis.

Results

PH > 35 mmHg was found in 23 (30.6%) of the 75 patients studied. The groups differed in extracellular water, ventricular thickness, left atrium diameter, and ventricular filling. In a univariate analysis, extracellular water was associated with PH (relative risk = 1.194; 95% CI of 1.006 – 1.416; p = 0.042); nevertheless, in a multiple model, only left atrium enlargement was independently associated with PH (relative risk =1.172; 95% CI of 1.010 – 1.359; p = 0.036). PH (hazard risk = 3.008; 95% CI of 1.285 – 7.043; p = 0.011) and age (hazard risk of 1.034 per year of age; 95% CI of 1.000 – 7.068; p = 0.047) were significantly associated with mortality in a multiple Cox regression analysis. However, when albumin was taken in account the only statistically significant association was between albumin level and mortality (hazard risk = 0.342 per g/dL; 95% CI of 0.119 – 0.984; p = 0.047) while the presence of PH lost its statistical significance (p = 0.184). Mortality was higher in patients with PH (47.8% vs 25%) who also had a statistically worse survival after the sixth year of follow up.

Conclusions

PH in hemodialysis patients is associated with parameters of volume overload that sheds light on its pathophysiology. Mortality is higher in hemodialysis patients with PH and the low albumin level can explain this association.

【 授权许可】

   
2012 Yoo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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