Pulmonary Arterial Hypertension Survival May Be Linked to Kidney Function

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

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. 

Reference

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

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