Prevalence and factors associated with pulmonary hypertension in patients undergoing maintenance hemodialysis: a systematic review and meta-analysis.

BACKGROUND

Maintenance hemodialysis (MHD) is a primary treatment for end-stage kidney disease (ESKD). Patients on long-term MHD frequently develop cardiovascular complications, with pulmonary hypertension (PH) prevalence reported as high as 47%. Due to small sample sizes and inconsistent findings, associated factors for PH in MHD patients remain unclear.

OBJECTIVE

To evaluate the prevalence and associated factors of PH in MHD patients.

METHODS

We systematically searched literature on PH risk factors in MHD patients across PubMed, Web of Science, CINAHL, Cochrane Library, Embase, CNKI, CBM, Wanfang, and VIP (inception to April 20, 2026). Two reviewers independently screened and extracted data. Data were synthesized using Stata 18.0.

RESULTS

Thirty-nine studies comprising 6,633 subjects were included, of whom 3,930 were males and 2,703 were females. The pooled PH prevalence was 37% (95% CI: 0.32-0.42). Multiple factors were significantly associated with PH (P < 0.05). Significant associated factors included age ≥ 60 years (OR = 1.03, 95% CI: 1.02-1.05), vascular access modalities (OR = 7.84, 95% CI: 4.98-12.33), hs-CRP ≥ 6.0 mg/L (OR = 3.57, 95% CI: 2.41-5.30), interdialytic weight gain (continuous: OR = 18.39; binary classification: OR = 20.51), serous cavity effusion (OR = 3.03, 95% CI: 1.84-4.97), elevated NT-proBNP (OR = 1.07, 95% CI: 1.02-1.12), BNP increased (OR = 1.77, 95% CI: 1.06-2.97), E/A (OR = 3.00, 95% CI: 1.89-4.75), enlarged LAD (OR = 1.17, 95% CI: 1.09-1.25), enlarged LVEDD (OR = 1.11, 95% CI: 1.05-1.17), Increased LVPWTd (OR = 1.72, 95% CI: 1.31-2.26), enlarged RAD (OR = 1.17, 95% CI: 1.12-1.22), and valvular regurgitation (OR = 3.83, 95% CI: 2.39-6.13). Reduced LVEF (OR = 0.92, 95% CI: 0.87-0.97) was inversely associated with PH.

CONCLUSION

The high PH prevalence in MHD patients, influenced by diverse factors, calls for enhanced clinical vigilance. Management should focus on early identification of high-risk patients, strengthened volume management, inflammation control, and cardiac monitoring. This approach is essential to lower PH risk and improve cardiovascular prognosis.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261378052.