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

BMC Nephrology

Research Article

Beatriz Bojikian Matsubara¹  Silméia Garcia Zannati-Bazan¹  Ana Claudia Kochi²  Jacqueline Teixeira Caramori²  Pasqual Barretti²  Luis Cuadrado Martin²  Lidiane Silva Rodrigues-Telini²  Roberto Jorge da Silva Franco²  Hugo Hyung Bok Yoo³  Thais Thomaz Queluz³ 

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

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

DOI  :  10.1186/1471-2369-13-80

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

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsWe 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.ResultsPH > 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.ConclusionsPH 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】

Unknown   
© Yoo et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.