Association of Pulmonary Hypertension With Inflammation and Fluid Overload in Hemodialysis Patients

Authors

  • Hugo Hyung Bok Yoo Division of Pulmonology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil
  • Roberto Dos Reis Division of Pulmonology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil
  • Wagner Moneda Telini Division of Pulmonology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil
  • Lidiane Rodrigues Telini Division of Nephrology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil
  • João Carlos Hueb Division of Cardiology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil
  • Silmeia Garcia Zanati Bazan Division of Cardiology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil
  • Pasqual Barretti Division of Nephrology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil
  • Luis Cuadrado Martin Division of Nephrology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil
  • Thais Thomaz Queluz Division of Pulmonology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil

Abstract

Introduction. Pulmonary hypertension (PH) has been reported in hemodialysis patients, but data regarding its pathogenesis are scarce. This study aimed to evaluate the role of fluid overload in PH and its interrelationships with the usual biomarkers of micro-inflammatory state in hemodialysis patients.

Materials and Methods. In is a cross-sectional and prospective study, 119 consecutive hemodialysis patients at a Brazilian referral university hospital were evaluated between March 2007 and February 2013. Based on the presence of echocardiographic parameters of PH, patients were allocated to two groups of the PH group and the non-PH group. Clinical parameters, site and type of vascular access, bio-impedance, and laboratory findings were compared between the two groups and a logistic regression model was elaborated.

Results. Pulmonary hypertension was found in 23 (19.0%) of 119 patients. The groups significantly differed in extracellular water, ventricular thickness, left atrium diameter, and ventricular filling. Additionally, laboratory data associated with PH were alpha-1-acid glycoprotein (140.0 ± 32.9 versus 116.0 ± 35.5; P < .001); C-reactive protein (median, 1.1 versus 1.6; P = .01) and B-type natriuretic peptide (median, 328 versus 77; P = .03). The adjusted logistic regression model, including alpha-1-acid glycoprotein and B-type natriuretic peptide, showed significant associations for both (odds ratio, 1.023; 95% confidence interval, 1.008 to 1.043;  P = .004 and odds ratio, 3.074; 95% confidence interval, 1.49-6.35; P = .002, respectively).

Conclusions. Pulmonary hypertension, cardiac hypertrophy, fluid overload, and inflammation were associated to each other in hemodialysis patients, providing insight into its pathogenesis. Longitudinal studies are warranted.

Author Biographies

  • Hugo Hyung Bok Yoo, Division of Pulmonology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil

    Pulmonary Division- Department of Internal Medicine

    Botucatu Medical School - São State University-UNESP

  • Roberto Dos Reis, Division of Pulmonology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil

    Pulmonary Division- Department of Internal Medicine

    Botucatu Medical School - São State University-UNESP

  • Wagner Moneda Telini, Division of Pulmonology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil

    Pulmonary Division- Department of Internal Medicine

    Botucatu Medical School - São State University-UNESP

  • Lidiane Rodrigues Telini, Division of Nephrology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil

    Department of Internal Medicine

    Botucatu Medical School - São State University-UNESP

  • João Carlos Hueb, Division of Cardiology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil

    Cardiology Division-Department of Internal Medicine

    Botucatu Medical School - São State University-UNESP

  • Silmeia Garcia Zanati Bazan, Division of Cardiology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil

    Cardiology Division-Department of Internal Medicine

    Botucatu Medical School - São State University-UNESP

  • Pasqual Barretti, Division of Nephrology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil

    Nephrology Division-Department of Internal Medicine

    Botucatu Medical School - São State University-UNESP

  • Luis Cuadrado Martin, Division of Nephrology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil

    Nephrology Division-Department of Internal Medicine

    Botucatu Medical School - São State University-UNESP

  • Thais Thomaz Queluz, Division of Pulmonology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil

    Pulmonary Division-Department of Internal Medicine

    Botucatu Medical School - São State University-UNESP

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Published

2017-06-02

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Section

ORIGINAL | Dialysis