RATIONALE & OBJECTIVE Pulmonary hypertension (PH) contributes to cardiovascular disease and mortality in patients with chronic kidney disease (CKD), but the pathophysiology is mostly unknown. This study sought to estimate the prevalence and consequences of PH subtypes in the setting of CKD. STUDY DESIGN Observational retrospective cohort study. SETTING & PARTICIPANTS We examined 12,618 patients with a right heart catheterization in the Duke Databank for Cardiovascular Disease from January 1, 2000, to December 31, 2014. EXPOSURES Baseline kidney function stratified by CKD glomerular filtration rate category and PH subtype. OUTCOMES All-cause mortality. ANALYTICAL APPROACH Multivariable Cox proportional hazards analysis. RESULTS In this cohort, 73.4% of patients with CKD had PH, compared with 56.9% of patients without CKD. Isolated postcapillary PH (39.0%) and combined pre- and postcapillary PH (38.3%) were the most common PH subtypes in CKD. Conversely, precapillary PH was the most common subtype in the non-CKD cohort (35.9%). The relationships between mean pulmonary artery pressure, pulmonary capillary wedge pressure, and right atrial pressure with mortality were similar in both the CKD and non-CKD cohorts. Compared with those without PH, precapillary PH conferred the highest mortality risk among patients without CKD (HR, 2.27; 95% CI, 2.00-2.57). By contrast, in those with CKD, combined pre- and postcapillary PH was associated with the highest risk for mortality in CKD in adjusted analyses (compared with no PH, HRs of 1.89 [95% CI, 1.57-2.28], 1.87 [95% CI, 1.52-2.31], 2.13 [95% CI, 1.52-2.97], and 1.63 [95% CI, 1.12-2.36] for glomerular filtration rate categories G3a, G3b, G4, and G5/G5D). LIMITATIONS The cohort referred for right heart catheterization may not be generalizable to the general population. Serum creatinine data in the 6 months preceding catheterization may not reflect true baseline CKD. Observational design precludes assumptions of causality. CONCLUSIONS In patients with CKD referred for right heart catheterization, PH is common and associated with poor survival. Combined pre- and postcapillary PH was common and portended the worst survival for patients with CKD.

中文翻译：

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CKD患者的肺动脉高压亚型和死亡率。

理性与目标肺动脉高压（PH）会导致慢性肾脏病（CKD）患者的心血管疾病和死亡，但其病理生理学尚不清楚。这项研究试图评估CKD背景下PH亚型的患病率和后果。研究设计观察性回顾性队列研究。背景与参与者我们从2000年1月1日至2014年12月31日在Duke心血管疾病数据库中检查了12,618例右心导管检查的患者。暴露基线肾功能按CKD肾小球滤过率类别和PH亚型分层。结果全因死亡率。分析方法多变量Cox比例风险分析。结果在这一队列中，有CKD的患者中有73.4％患有PH，而没有CKD的患者中有56.9％患有PH。在CKD中最常见的PH亚型是孤立的毛细血管后PH（39.0％）和毛细血管前和毛细血管合并PH（38.3％）。相反，在非CKD人群中，毛细血管前PH是最常见的亚型（35.9％）。在CKD和非CKD队列中，平均肺动脉压，肺毛细血管楔压和右心房压与死亡率之间的关系相似。与没有PH的患者相比，毛细血管前PH在没有CKD的患者中具有最高的死亡风险（HR，2.27； 95％CI，2.00-2.57）。相比之下，在患有CKD的患者中，在校正后的分析中，合并毛细血管前和毛发后PH与CKD死亡率最高的风险相关（与无PH相比，HR分别为1.89 [95％CI，1.57-2.28]，1.87 [95％] CI，1.52-2.31]，2.13 [95％CI，1.52-2.97]和1.63 [95％CI，1.12-2。36]表示肾小球滤过率类别G3a，G3b，G4和G5 / G5D）。局限性右心导管检查的队列可能无法推广到一般人群。导尿前6个月的血清肌酐数据可能无法反映出真实的基线CKD。观察性设计排除了因果关系的假设。结论在右心导管检查的CKD患者中，PH很常见，并且与生存期差有关。合并毛细血管化前后的PH很常见，预示着CKD患者的生存期最差。观察性设计排除了因果关系的假设。结论在右心导管检查的CKD患者中，PH很常见，并且与生存期差有关。合并毛细血管化前后的PH很常见，预示着CKD患者的生存期最差。观察性设计排除了因果关系的假设。结论在右心导管检查的CKD患者中，PH很常见，并且与生存期差有关。合并毛细血管化前后的PH很常见，预示着CKD患者的生存期最差。