Pulmonary hypertension in dialysis patients: clinical insights from tricuspid regurgitation velocity (TRV)-based echocardiographic criteria.

The prevalence of pulmonary hypertension in dialysis patients using TRV-based echocardiographic criteria was 43.6%.

• 51 out of 117 dialysis patients met criteria for PH.
• PH was defined as TRV >2.8 m/s plus ≥1 additional echocardiographic sign per the 2022 ESC/ERS criteria.
• The study was conducted at Burapha University Hospital, Chonburi Province, Thailand, from October 1, 2023, to October 30, 2024.
• This stricter TRV-based definition was used to reduce misclassification related to volume status compared to earlier PASP >35 mmHg criteria.

Longer dialysis vintage was an independent predictor of pulmonary hypertension in dialysis patients.

• Adjusted relative risk (ARR) was 1.50 per year of dialysis vintage (p = 0.009).
• This association was identified in multivariable analysis.
• The finding suggests that cumulative exposure to dialysis-related cardiovascular stressors contributes to PH development over time.

Larger left ventricular diastolic dimension was an independent predictor of pulmonary hypertension.

• Adjusted relative risk was 1.06 per mmHg increase in LV diastolic dimension (p = 0.036).
• PH patients had greater left ventricular diastolic dimensions compared to non-PH patients.
• This was identified in multivariable analysis alongside dialysis vintage and mitral regurgitation.

The presence of mitral regurgitation (MR) was an independent predictor of pulmonary hypertension.

• Adjusted relative risk for MR was 2.00 (p = 0.020).
• MR was more frequent in PH patients compared to non-PH patients on univariable comparison.
• The association with MR supports a predominance of post-capillary mechanisms in dialysis-related PH.

Patients with pulmonary hypertension had worse echocardiographic left-sided cardiac parameters compared to non-PH patients.

• PH patients had greater left ventricular diastolic dimensions than non-PH patients.
• PH patients had higher left atrial volume index compared to non-PH patients.
• PH patients had more diastolic dysfunction than non-PH patients.
• PH patients had more frequent mitral regurgitation than non-PH patients.

Earlier echocardiographic definitions based on PASP >35 mmHg were considered prone to inaccuracy and volume overload bias in dialysis patients.

• The 2022 ESC/ERS guidelines introduced TRV-based criteria incorporating structural and functional markers to improve diagnostic specificity.
• The new criteria were designed to reduce misclassification related to volume status.
• PH is described as 'a frequent yet underrecognized complication in end-stage renal disease on dialysis.'
• PASP estimation from right atrial pressure was identified as a source of inaccuracy in prior definitions.

The observed clinical associations support a heart-kidney-lung interaction with post-capillary mechanisms predominating in dialysis-related pulmonary hypertension.

• Independent predictors (dialysis vintage, LV remodeling, and MR) collectively suggest post-capillary PH mechanisms.
• The authors describe the findings as supporting 'a heart-kidney-lung interaction.'
• LV diastolic dysfunction and elevated left atrial volume index in PH patients are consistent with left-sided cardiac disease driving PH.
• This was a retrospective cross-sectional study of 117 patients, limiting causal inference.