1. ¹Division of Pulmonary Medicine, Rambam Health Care Campus and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Haifa, Israel
2. ²Department of Cardiology, Rambam Health Care Campus and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Haifa, Israel
3. ³Department of Nephrology, Rambam Health Care Campus and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Haifa, Israel
4. ⁴Ambulatory Nephrology Unit, Rambam Health Care Campus and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Haifa, Israel

Correspondence: Mordechai Yigla, Division of Pulmonary Medicine, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel. E-mail: m_yigla@rambam.health.gov.il

Received 31 October 2007; Revised 17 December 2008; Accepted 23 December 2008; Published online 11 February 2009.

Abstract

Pulmonary hypertension in patients with end-stage renal disease on hemodialysis is a newly described entity. To determine its impact, we measured selected clinical variables in the survival of 127 hemodialysis patients. Overall, pulmonary hypertension was found in 37 of these patients; it was already prevalent in 17 of them before initiation of dialysis and was associated with severe cardiac dysfunction. In the other 20 it developed after dialysis began, without obvious cause. These two subgroups of patients had similar survival curves, which were significantly worse in comparison to those without pulmonary hypertension. Following the initiation of hemodialysis, 20 patients with otherwise matched clinical variables survived significantly longer than the 20 who developed pulmonary hypertension after dialysis began. With univariate analysis, significant hazard ratios were found for age at onset of hemodialysis therapy (1.7), valvular diseases (1.8), pulmonary hypertension prevalence before hemodialysis (3.6) and incident after hemodialysis (2.4) for predicting mortality. In a multivariable Cox proportional hazard model, the development of pulmonary hypertension both before and after initiation of hemodialysis had significantly increased odds ratios and remained an independent predictor of mortality. Our study shows the incidence of pulmonary hypertension, after initiation of hemodialysis therapy, is a strong independent predictor of mortality nearly equal to that associated with long-standing severe cardiac abnormalities.