Renal Function Improves Mortality Risk Assessment in Pulmonary Arterial Hypertension

In patients with pulmonary arterial hypertension (PAH), renal function is important for determining mortality risk and improves stratification of risk, according to the results of a retrospective study published in The Journal of Heart and Lung Transplantation.

Renal disease is a critical prognostic marker across many cardiovascular disease states and is prevalent in up to 36% to 47% of patients with PAH. However, despite the importance of renal function in patients with PAH, it has not been formally incorporated into many contemporary PAH risk assessment tools. Thus, researchers sought to compare contemporary risk assessment tools and determine the prognostic significance of risk parameters of kidney function and whether they can further improve risk prediction, particularly for those patients considered at intermediate risk.

A total of 211 treatment naive patients with PAH were categorized as low, intermediate, or high risk according to the European Society of Cardiology (ESC)/European Respiratory Society (ERS) 2015 guidelines, the French Pulmonary Hypertension Registry 2015 strategy, and the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) 1.0 and 2.0 risk calculators. The primary end point was transplant-free survival, which was a median of 7.09 years in the patient population.

The researchers observed little agreement between ESC- and REVEAL-based estimates. It was found that both ESC and REVEAL algorithms stratified transplant-free survival risk, with the REVEAL score providing superior discrimination (P =.004). Both renal function at diagnosis (P <.0001) and change in renal function at 6 months (P <.0001) were identified as novel risk parameters and were used to reclassify some patients from intermediate risk to low or high risk.

The authors concluded, “Our work highlights key limitations of the ESC/ERS-based risk assessment, and suggests that incorporating measures of kidney function are important strategies moving forward.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Zelt JGE, Hossain A, Sun LY, et al. Incorporation of renal function in mortality risk assessment for pulmonary arterial hypertension [published online April 5, 2020]. J Heart Lung Transplant. doi:10.1016/j.healun.2020.03.026