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Kidney Week

Abstract: PO2069

Risk of Mortality, ESKD, and Hospitalization Among Medicare Beneficiaries with Pulmonary Hypertension and CKD

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Walther, Carl P., Baylor College of Medicine, Houston, Texas, United States
  • Gregg, L Parker, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
  • Nambi, Vijay, Baylor College of Medicine, Houston, Texas, United States
  • Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States
Background

Pulmonary hypertension (PH) is highly prevalent among patients with non-dialysis dependent CKD (~20%). We studied the risks of mortality, ESKD, cardiovascular (CV) and non-CV hospitalizations among those diagnosed with both PH and CKD.

Methods

Patients with PH (based on 2 claims within 2 years) were identified from a Medicare 5% sample (1995-2016). For each PH patient we randomly selected 5 patients diagnosed with the same CKD stage as the PH patient but without a PH diagnosis. We used Cox proportional hazards models to assess the association between PH and mortality, adjusting for age, sex, race, and comorbidities. We considered death as a competing event in Fine-Gray models to assess the association between PH and ESKD.

Results

We studied 41,478 patients with PH and CKD and 207,390 CKD stage-matched patients without diagnosed PH. Over 59% of the study population were >80 years, 12% were African American, 47% had diagnosed diabetes and 46% had COPD. The presence of diagnosed PH (vs. no PH diagnosis) was associated with increased risk of mortality, ESKD, and CV and non-CV hospitalizations at 1-, 3-, and 5-year follow-up (Table 1). Diabetes modified these associations with higher risk of all outcomes noted among those without diabetes.

Conclusion

Among older Medicare beneficiaries diagnosed with CKD, the presence of PH increased risk of mortality, ESKD, and hospitalization. Mechanistic understanding of these associations, especially the increased risk of ESKD, requires additional study.

Table 1. Associations of PH with mortality, ESKD, and cardiovascular and non-CV hospitalization in those with PH and CKD
Outcome Unadjusted HR (95% CI)
Multivariable adjusted
HR (95% CI)
Mortality1-year3.24 (3.17, 3.31)
2.35(2.29, 2.41)
 3-year2.71(2.67, 2.75)
1.98 (1.94, 2.01)
 5-year2.54(2.50, 2.58)
1.87 (1.84, 1.90)
ESKD1-year2.73 (2.57, 2.90)
2.49 (2.33, 2.67)
 3-year1.82 (1.74, 1.91)
1.70 (1.61, 1.79)
 5-year1.59 (1.52, 1.66)
1.54 (1.47, 1.62)
  Unadjusted RR (95% CI)
Multivariable adjusted
RR (95% CI)
Cardiovascular hospitalization
1-year7.97 (7.82, 8.13)
5.92 (5.80, 6.05)
 3-year6.72 (6.60, 6.83)
4.77(4.68, 4.85)
 5-year6.39 (6.28, 6.49)
4.48 (4.40, 4.56)
Non-CV hospitalization
1-year3.83 (3.77, 3.89)
2.98 (2.93, 3.03)
 3-year3.36 (3.31, 3.40)
2.54 (2.51, 2.58)
 5-year3.20 (3.15, 3.24)
2.41 (2.38, 2.45)

Funding

  • NIDDK Support