Source: Annual Congress 2011 - Physiology of human pulmonary hypertension
Disease area: Pulmonary vascular diseases

Abstract

Background:
Pulmonary arterial hypertension is disease of the pulmonary vasculature that results in right ventricular (RV) failure and death. Renal insufficiency is recently identified as a key predictor of mortality in PAH patients¹. Renal dysfunction is associated with decreased cardiac output (CO) in patients with left heart failure. However, little is known about the mechanisms of renal dysfunction and its association with venous congestion in PAH patients with RV dysfunction.
Objectives:
To investigate the relationship between CO, right atrial pressure (RAP) and estimated glomerular filtration rate (eGFR) in patients with PAH.
Methods:
74 patients underwent baseline right heart catheterization to determine CO and RAP and blood sampling to calculate eGFR. These measurements were repeated in 30 patients after 12 ± 1 months of follow-up.
Results:
Mean age was 52±15 years and 73% of subjects were female. Mean eGFR was 88±24 ml/min/1.73m², mean CO was 5.1±1.7 L/min and mean RAP was 7.0±5 mmHg. Low eGFR at baseline was associated with low CO (R=0.46; p<.0001) and high RAP (R=-0.20; p=0.042). Multivariate regression analysis showed that CO was an independent determinant of eGFR (p=0.01).
After 1 year follow-up, eGFR remained stable, RAP remained unchanged and CO slightly increased (0.9±2.7 L/min; p=0.045). Changes in eGFR were determined by changes in CO (R=0.45; p=0.011) and RAP (R=-0.370; p=0.031). Multivariate analysis revealed that changes in CO were independently related to changes in eGFR (p=0.043).
Conclusions:
CO is the main determinant of renal dysfunction in patients with pulmonary arterial hypertension and RV dysfunction.
References:
1. Benza et al. Circulation 2010

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Citations should be made in the following way:
M. van de Veerdonk, A. Vonk-Noordegraaf (Amsterdam, Netherlands). Association of renal dysfunction with cardiac output and right atrial pressure in pulmonary arterial hypertension. Eur Respir J 2011; 38: Suppl. 55, 2305

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