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

Pulmonary hypertension (PH) is a frequent yet underrecognized complication in end-stage renal disease on dialysis. Earlier echocardiographic definitions based on pulmonary artery systolic pressure (PASP) >35 mmHg derived from right atrial pressure estimation were prone to inaccuracy and volume overload bias. In 2022, the European Society of Cardiology/European Respiratory Society introduced tricuspid regurgitation velocity (TRV)-based criteria incorporating structural and functional markers to improve diagnostic specificity. We aimed to determine the prevalence of PH in dialysis patients using TRV-based echocardiographic criteria and to identify independent predictors. This retrospective cross-sectional study was conducted at Burapha University Hospital, Chonburi Province, Thailand, from October 1, 2023, to October 30, 2024, and included 117 dialysis patients who underwent echocardiography. PH was defined as TRV >2.8 m/s plus ≥1 additional echocardiographic sign. The prevalence of PH was 43.6% (51/117). Compared with non-PH patients, those with PH had greater left ventricular diastolic dimensions, higher left atrial volume index, more diastolic dysfunction, and more frequent mitral regurgitation (MR). In multivariable analysis, longer dialysis vintage (adjusted relative risk [ARR] 1.50 per year, p = 0.009), larger LV diastolic dimension (ARR 1.06 per mmHg, p = 0.036), and the presence of MR (ARR 2.00, p = 0.020) were independent predictors. PH was common in dialysis patients even when applying stricter TRV-based criteria that reduce misclassification related to volume status. The observed associations with dialysis vintage, left ventricular remodeling, and MR suggest a predominance of post-capillary mechanisms and support a heart-kidney-lung interaction.