Predictors, prevalence and prognostic role of pulmonary hypertension in patients with chronic kidney disease: a systematic review and meta-analysis

To estimate the predictors, prevalence and prognostic role of pulmonary hypertension (PH) in patients with chronic kidney disease (CKD) using meta-analysis. The PubMed, EmBase, and the Cochrane library were systematically searched for eligible studies from inception till May 2024. All of pooled analyses were performed using the random-effects model. Fifty observational studies involving 17,558 CKD patients were selected. The prevalence of PH in CKD patients was 38% (95% confidence interval [CI]: 33%–43%), and the prevalence according to CKD status were 31% (95% CI: 20%–42%) for CKD (I-V), 39% (95% CI: 25%–54%) for end stage kidney disease (ESKD) (predialysis), 42% (95% CI: 35%–50%) for ESKD (hemodialysis), and 26% (95% CI: 19%–34%) for renal transplant. We noted the risk factors for PH in CKD included Black individuals (relative risk [RR]: 1.39; 95% CI: 1.18–1.63; <i>p</i> &lt; 0.001), chronic obstructive pulmonary disease (RR: 1.48; 95% CI: 1.21-1.82; <i>p</i> &lt; 0.001), cardiovascular disease history (RR: 1.62; 95% CI: 1.05–2.51; <i>p</i> = 0.030), longer dialysis (RR: 1.70; 95% CI: 1.18–2.46; <i>p</i> = 0.005), diastolic dysfunction (RR: 1.88; 95% CI: 1.38–2.55; <i>p</i> &lt; 0.001), systolic dysfunction (RR: 3.75; 95% CI: 2.88–4.87; <i>p</i> &lt; 0.001), and grade 5 CKD (RR: 5.64; 95% CI: 3.18–9.98; <i>p</i> &lt; 0.001). Moreover, PH in CKD patients is also associated with poor prognosis, including all-cause mortality, major cardiovascular events, and cardiac death. This study systematically identified risk factors for PH in CKD patients, and PH were associated with poor prognosis. Therefore, patients with high prevalence of PH should be identified for treatment.

本研究旨在通过荟萃分析（meta-analysis）评估慢性肾脏病（chronic kidney disease, CKD）患者中肺动脉高压（pulmonary hypertension, PH）的预测因素、患病率及其预后价值。本研究系统检索了PubMed、EmBase及Cochrane图书馆自建库至2024年5月的符合纳入标准的相关研究，所有合并分析均采用随机效应模型完成。最终纳入50项观察性研究，共涉及17558例CKD患者。慢性肾脏病患者中肺动脉高压的总体患病率为38%（95%置信区间[CI]：33%~43%）；按慢性肾脏病分期细分，CKD（I~V期）患者的PH患病率为31%（95%CI：20%~42%），终末期肾病（end stage kidney disease, ESKD）未透析患者为39%（95%CI：25%~54%），ESKD血液透析患者为42%（95%CI：35%~50%），肾移植受者为26%（95%CI：19%~34%）。本研究发现，慢性肾脏病患者合并肺动脉高压的危险因素包括黑人人群（相对风险[RR]：1.39；95%CI：1.18~1.63；*p*<0.001）、慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）（RR：1.48；95%CI：1.21~1.82；*p*<0.001）、心血管疾病病史（RR：1.62；95%CI：1.05~2.51；*p*=0.030）、更长的透析时长（RR：1.70；95%CI：1.18~2.46；*p*=0.005）、舒张功能障碍（RR：1.88；95%CI：1.38~2.55；*p*<0.001）、收缩功能障碍（RR：3.75；95%CI：2.88~4.87；*p*<0.001）以及5期CKD（RR：5.64；95%CI：3.18~9.98；*p*<0.001）。此外，慢性肾脏病患者合并肺动脉高压还与不良预后显著相关，包括全因死亡、主要心血管事件及心源性死亡。本研究系统明确了慢性肾脏病患者合并肺动脉高压的危险因素，且肺动脉高压与不良预后密切相关。因此，需对肺动脉高压患病率较高的慢性肾脏病患者进行筛查并予以干预治疗。