Kidney Week

Abstract: FR-PO358

Association of Kidney Function and Volume Overload with Incident Pulmonary Hypertension in the Chronic Renal Insufficiency Cohort (CRIC) Study

Session Information

• Hypertension, CVD, and the Kidneys: Epidemiology
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Tuttle, Marcelle, Tufts Medical Center, Boston, Massachusetts, United States

Marcelle Tuttle, MD

• Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States

Hocine Tighiouart, MS

• Oka, Tatsufumi, Osaka Daigaku, Suita, Osaka, Japan

Tatsufumi Oka, MD, PhD

• McCallum, Wendy I., Tufts Medical Center, Boston, Massachusetts, United States

Wendy I. McCallum, MD, MS

• Hill, Nicholas S., Tufts Medical Center, Boston, Massachusetts, United States

Nicholas S. Hill, MD

• Kawut, Steven, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Steven Kawut, MD

• Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States

Mark J. Sarnak, MD, MS

Background

Pulmonary hypertension (PH) is common in patients with chronic kidney disease (CKD), but very few studies have examined risk factors for its development. Tricuspid regurgitation velocity (TRV) measured on echocardiogram (TTE) estimates the pressure difference between the right ventricle and the right atrium and correlates with pulmonary artery systolic pressure.

Methods

We included patients without prevalent PH with 2 or more TRV measurements in the CRIC Study. PH was defined as a TRV >= 2.8 m/s. Incident PH was defined as PH on the final TTE. Estimated glomerular filtration rate (eGFR), 24-hour urine albumin, and brain natriuretic peptide (BNP) were considered as the main independent variables. eGFR was calculated using the CKD-EPI 2021 equation. Multivariable logistic regression adjusting for demographics, comorbid conditions, and medications was used to evaluate the relation of kidney function and BNP to incident PH. In further exploratory models, eGFR models additionally adjusted for BNP and vice versa.

Results

The study sample included 848 subjects. At baseline mean eGFR was 45.3 ml/min/1.73m² (SD 14.7), median 24-hour urine albumin was 24.8 mg (IQR 7.3, 142.8), and median BNP was 36.6 pg/ml (IQR 15.8, 64.4). 103 (10.4%) subjects developed PH over a mean (SD) of 3.8 (1.3 years). Lower baseline eGFR was associated with higher odds of developing PH, but the effect was slightly attenuated after adjustment for BNP (Table). BNP was associated with higher odds of incident PH regardless of adjustment. There was no association between albuminuria and incident PH.

Conclusion

Higher baseline BNP and lower eGFR are associated with incident PH in CKD. Volume appears to be a key risk factor for the development of PH in patients with CKD.

Funding

• Other NIH Support