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Kidney Week

Abstract: SA-PO147

Recovery of Chronic Thromboembolic Pulmonary Hypertension (CTEPH)-Associated Renal Failure After Pulmonary Endarterectomy (PEA)

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Jameson, Robert L., Houston Methodist Hospital, Houston, Texas, United States
  • Nassar, George M., Houston Methodist Hospital, Houston, Texas, United States
  • Sathiyaraj, Steffi, Houston Methodist Hospital, Houston, Texas, United States
  • Bidikian, Nayda, Houston Methodist Hospital, Houston, Texas, United States
  • Villasmil Hernandez, Nelson Alberto, Houston Methodist Hospital, Houston, Texas, United States
  • Sahay, Sandeep, Houston Methodist Hospital, Houston, Texas, United States
Introduction

Chronic thromboembolic pulmonary hypertension (CTEPH) is a recognized cause of severe pulmonary hypertension (PH). Acute Kidney Injury (AKI) is a common occurrence in advanced cases of CTEPH and often progresses to require permanent renal replacement therapy (RRT). We present two patients with CTEPH and AKI who had persistent need for RRT; however, after successful pulmonary endarterectomy (PEA) both patients experienced renal recovery and no longer required RRT.

Case Description

Case 1: A 43-year-old male with antiphospholipid syndrome was hospitalized with congestive heart failure (CHF) and AKI. He was diagnosed with CTEPH by ventilation-perfusion scan and pulmonary angiogram. He underwent a right heart catheterization (RHC) which confirmed the presence of severe PH, and his echocardiogram revealed RV dysfunction. Despite intense pharmacological treatment for PH, he continued to require RRT and was discharged home on peritoneal dialysis. Five months later, he underwent a successful PEA and within 48 hours, he recovered from needing RRT. Two years later, he continues to be dialysis-free and maintains a serum creatinine of 1.7 mg/dl.

Case 2: A 57-year-old woman with known CTEPH was admitted due to worsening right-sided CHF and AKI. Her echocardiogram showed RV systolic dysfunction and severe tricuspid regurgitation. She initially required intensive critical care (ICU) management with vasopressors and continuous RRT (CRRT). After she stabilized, she underwent PEA and tricuspid valve repair. She was discharged on PH medications and dialysis. Renal recovery occurred over the next six months, following which she got off dialysis. Four years later, she was still dialysis free and had a creatinine of 1.96.

Discussion

This report demonstrates the reversal of dialysis-requiring AKI in CTEPH patients following PEA. PEA is a promising therapy for CTEPH with significant renal benefits and should be considered as the optimal treatment for patients with CTEPH and concomitant AKI.