Prevalence and risk factors of echocardiographically suspected pulmonary hypertension in maintenance hemodialysis patients: a retrospective study.

BACKGROUND

Pulmonary hypertension (PH) is a prevalent complication in maintenance hemodialysis (MHD) patients, contributing to increased cardiovascular morbidity. This study aimed to determine the prevalence and independent risk factors for echocardiographically suspected PH in a Chinese MHD cohort.

METHODS

This single-center retrospective cross-sectional study reviewed 948 MHD patients who underwent transthoracic echocardiography between January 2023 and December 2024. Suspected PH was consistently defined using standardized objective echocardiographic criteria (estimated pulmonary artery systolic pressure > 35 mmHg), with qualitative right-heart markers serving as supportive criteria only when tricuspid regurgitant jets were unmeasurable. Following rigorous data cleaning to remove extreme outliers, a prespecified multivariable logistic regression model-adjusted for core clinical confounders-was used to identify independent predictors.

RESULTS

The prevalence of echocardiographically suspected PH was 29.7% (282/948). Patients with suspected PH had significantly lower hemoglobin (107.48 ± 23.70 vs. 113.10 ± 23.93 g/L, p = 0.001) and serum albumin (41.79 ± 5.22 vs. 43.03 ± 4.40 g/L, p < 0.001), alongside markedly higher median brain natriuretic peptide levels (414.30 [IQR: 132.46-1466.23] vs. 124.25 [IQR: 50.30-338.54] pg/mL, p < 0.001). After multivariable adjustment for age, sex, diabetes, hypertension, and dialysis vintage, independent predictors included larger left atrial diameter (OR 1.292, 95% CI 1.223-1.364, p < 0.001), lower left ventricular ejection fraction (OR 0.954, 95% CI 0.927-0.981, p = 0.001), history of thrombectomy (OR 2.450, 95% CI 1.249-4.807, p = 0.009), and history of percutaneous transluminal angioplasty (PTA) (OR 1.511, 95% CI 1.014-2.250, p = 0.042).

CONCLUSION

Echocardiographically suspected PH affects approximately 30% of Chinese MHD patients. It is significantly and independently associated with left-sided cardiac remodeling and a history of severe vascular access interventions.