Pulmonary Arterial Hypertension Survival May Be Linked to Kidney Function

kidney CAT scan
kidney CAT scan
A study evaluated whether changes in estimated glomerular filtration rate were predictive of mortality in patients with pulmonary arterial hypertension.

In patients diagnosed with pulmonary arterial hypertension (PAH), a decrease in baseline estimated glomerular filtration rate (eGFR) ≥10% may be an independent predictor of all-cause hospitalizations and overall survival, according to a study published in the Journal of Heart and Lung Transplantation.

A prospective study of 2368 individuals aged 18 years or older diagnosed with catheterization-confirmed PAH were categorized according to chronic kidney disease (CKD) stage based upon their eGFR (normal or stages 1 and 2 (n=1699), stage 3a (n=399), stage 3b (n=196), stage 4, and stage 5 (n=74). The relationships between CKD stage and survival were evaluated.

The researchers found a significantly increased risk for mortality (hazard ratio [HR], 1.66; P <.0001) in patients with an eGFR decline from baseline of ≥10% over the course of ≥1 year. 

An increased risk for composite all-cause hospitalization and death was also found in patients with an eGFR decline from baseline of ≥10% (HR, 1.33; P =.002). Of note, there was no significant relationship between a ≥10% increase in eGFR and either of these end points (HR, 1.17; P =.178).

Researchers concluded that in patients with PAH, both baseline eGFR and a ≥10% decline in eGFR over the course of time may be independent predictors of patient survival and all-cause hospitalization. 

Therefore, this reliable, inexpensive, common test can be used by clinicians as a treatment guide, and prognostic biomarker in patients with both CKD and PAH. 

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Chakinala MM, Coyne DW, Benza RL, et al.  Impact of declining renal function on outcomes in pulmonary arterial hypertension: a REVEAL registry analysis [published online November 6, 2017]. J Heart Lung Transplant. doi:10.1016/j.healun.2017.10.028