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Kidney Week

Abstract: TH-PO1137

Prevalence of Pulmonary Hypertension in Patients Listed Active for Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Kant, Sam, Johns Hopkins University Hospital, Baltimore, Maryland, United States
  • Iroegbu, Christin, Johns Hopkins University Hospital, Baltimore, Maryland, United States
  • Alasfar, Sami, Johns Hopkins University Hospital, Baltimore, Maryland, United States
  • Naqvi, Fizza F., Johns Hopkins University Hospital, Baltimore, Maryland, United States
  • Brennan, Daniel C., Johns Hopkins University Hospital, Baltimore, Maryland, United States
Background

Pulmonary hypertension (PH) is variably defined,with estimated prevalence in CKD and ESRD of 9% and 19%,respectively.PH at the time of kidney transplantation (KTx) can portend a lower graft survival and the prevalence in wait-listed patients is unknown.We sought to ascertain the prevalence of PH in patients listed active for KTx and characterize based on demographics, comorbidities and ECHO characteristics at our center

Methods

A chart review of EPIC EMR was conducted by assessing problem lists,clinic evaluations and ECHO results for patients listed active for KTx at our institution from 2014-2019.We recorded basic demographics, ESRD cause, type of dialysis access,vintage and modality,listing duration, associated comorbidities and comprehensive ECHO measurements.PH was defined as RVSP>35 mm Hg on ECHO

Results

Of 634 patients listed active during this period,104(17%) patients had ECHO evidence of PH.Demographics and ECHO data are shown in Table 1.Mean age of patients was 57 years,with 61% male, 59% African-American and mean BMI of 29.1.Diabetes was the most prevalent cause of ESRD (38%),75% were on HD and 70% had an AVF as dialysis access.Median dialysis vintage was 36 months and listing duration was 20 months; 25% had a history of obstructive sleep apnea (OSA) and 30% had coronary artery disease.The mean RVSP was 44.7 mm Hg (SD 8.7,range 35-83), 25% of patients with evidence of PH on ECHO were formally reviewed by a cardiologist,only 3 of whom had PH diagnosed and classified as per WHO criteria.Other ECHO findings showed 57% had HFpEF and 22% had valve abnormalities (moderate-severe)

Conclusion

This is the one of the largest studies to elucidate prevalence, clinical and ECHO characteristics in patients with PH listed active for KTx.PH appears to be under-addressed and efforts should be made to ascertain its cause and direct intervention(eg.ultrafiltration,improving lung disease,and pulmonary vasculature vasodilators).Future studies could assess the effect of interventions on post KTx outcomes, particularly in groups stratified by PH severity.

Table 1. Demographics and Echocardiogram Characteristics in Patients with PH Listed Active for KTx
Age, mean (SD) 57.0 (13.3)

Male, n (%) 61 (58.6)

Race
African-American, n (%) 59 (56.7)
Caucasian, n (%) 32 (30.7)
Other, n (%) 13 (12.5)

ESRD cause
Diabetes 38 (36.5)
HTN 28 (26.9)
Other GN 16 (15.3)
Other specified 9 (8.6)
Idiopathic 5 (4.8)
PCKD 4 (3.8)
GN (CTD) 4 (3.8)

BMI, mean (SD) 29.1 (5.3)
Normal (<25), n (%) 26 (25)
Overweight (25-29), n (%) 33 (31.7)
Obese (30-35), n (%) 31 (29.8)
Morbidly obese (>35), n (%) 14 (13.4)
Dialysis type

HD, n (%) 75 (72.1)
PD, n (%) 16 (15.4)
CKD IV/V, n (%) 13 (12.5)

Dialysis access

AVF, n (%) 70 (67.3)
AVF on PD, n (%) 1 (0.9)
AV graft, n (%) 3 (2.8)
Tunneled catheter, n (%) 5 (4.8)

Dialysis vintage, mths, median (IQR) 36 (25-55)

Listing duration, mths, mean (SD) 23.4 (17.2)

Listing duration, mths, median (IQR) 20 (9-35)
COPD, n (%) 9 (8.6)
Asthma, n (%) 4 (3.8)
OSA, n (%) 26 (25.0)

Smoking status
Current smoker 10 (9.6)
Ex-smoker 62 (59.6)
Never smoker 32 (30.7)

History of PE, n (%) 3 (2.8)
History of DVT, n (%) 5 (4.8)
HIV positive, n (%) 2 (1.9)
SLE, n (%) 2 (1.9)
Scleroderma, n (%) 3 (2.8)
HTN, n (%) 100 (96.1)
Hyperlipidemia, n (%) 70 (67.3)
Coronary artery disease, n (%) 30 (28.8)
Formal classification of pulmonary HTN, n (%) 3 (2.8)

Patient reviewed by cardiologist, n (%) 26 (25.0)

ECHO findings:

Heart failure status
HFrEF, n (%) 13 (12.5)
HFpEF, n (%) 57 (54.8)

Valvular abnormalities, n (%) 22 (21.2)
TR, n (%) 8 (7.7)
MR, n (%) 6 (5.7)
MR+TR, n (%) 5 (4.8)
AR, n (%) 3 (2.8)

LA size, mean (SD) 4.3 (0.6)
RA pressure, mean (SD) 7 (3.6)

RVSP, mean (SD) 44.7 (8.7)
RVSP 35-45, n (%) 60 (57.6)
RVSP 45-60, n (%) 35 (33.6)
RVSP >60, n (%) 9 (8.6)

TJ velocity, mean (SD) 303.3 (48.5)
LVEF, mean (SD) 56.1 (9.3)
RWMA, n (%) 13 (12.7)
EA ratio, mean (SD) 1.4 (0.6)