Abstract 20657: Influence of Gender on Pulmonary Hypertension Phenotype in Chronic Kidney Disease
Introduction: Pulmonary hypertension (PH) is common among CKD patients and associated with a worse prognosis. Risk factors for PH among CKD patients are poorly understood, particularly among the Pre-Capillary PH (Pre-PH) phenotype. We examined the risk factors and clinical correlates of Pre-PH in CKD.
Methods: We extracted clinical, hemodynamic and echocardiographic data from Vanderbilt’s de-identified electronic medical record in patients referred for right heart catheterization (RHC) between 1998-2014. CKD stage was defined by GFR thresholds.
Results: Among 4,635 patients referred for RHC, 1,267 (46%) had PH and CKD (stage 3 or greater). After adjustment for 24 relevant covariates, the recognized risk factors COPD, CHF, BMI, and scleroderma were associated with PH (all p<0.001) in addition to CKD (OR 1.40 95%CI 1.18-1.65, p<0.001) and black race (OR 1.56 95%CI 1.23-1.99; p<0.001). Established risk factors for pulmonary vascular disease (ILD, SLE, Scleroderma) were more prevalent in Pre-PH patients with CKD compared with post-capillary PH patients with CKD (Table). The proportion of females with CKD and Pre-PH was 73%, compared to 45% of CKD patients with Post-capillary PH (p<0.001). After adjusting for covariates, female gender (OR 2.16 95%CI 1.68-2.78, p<0.001) and higher hemoglobin (OR 2.68 95%CI 1.97-3.65, p<0.001) were strongly associated with Pre-PH. Among 302 Pre-PH CKD patients, 176 (58%) had no risk factors for pulmonary vascular disease. Compared with CKD patients with the same risk factors excluded, those with Pre-PH were significantly more likely to be female (75% vs. 49% p<0.001).
Conclusions: In our observational cohort, CKD commonly coexists with established risk factors for pulmonary vascular disease in patients with Pre-PH. Female gender is a strong risk factor for Pre-PH in CKD patients, including when no identifiable risk factors for PH are present. Further studies are warranted to examine the mechanisms underlying this association.
Author Disclosures: J. O’Leary: None. T. Assad: None. A. Hemnes: None. M. Xu: None. Q. Wells: None. E. Farber-Eger: None. K. Birdwell: None. E. Brittain: None.
- © 2016 by American Heart Association, Inc.