Patients with pulmonary hypertension at high risk for acute kidney injury

NASHVILLE, Tenn. — Patients admitted with background secondary pulmonary hypertension may have an increased risk for acute kidney injury and adverse outcomes, according to a presenter at the CHEST Annual Meeting.

“Our study, though preliminarily, suggests important clinical implications,” Akhil Jain, MD, resident physician at Mercy Catholic Medical Center in Darby, Pennsylvania, told Healio. “Patients having pulmonary hypertension may have increased chances of risk for acute kidney injury. Such patients may have poor in-hospital outcomes that warrant extra vigilance in their care. Screening for pulmonary hypertension itself should be encouraged in high-risk patients and emphasized by primary care physicians, internists and hospitalists so that subsequent complications like acute kidney injury can be identified and managed early.”

In an analysis of the National Inpatient Sample, Jain and colleagues evaluated 6 million hospitalizations of patients with pulmonary heart disease and diseases of pulmonary circulation (as for secondary pulmonary hypertension) from 2016 to 2019 to find trends and outcomes of acute kidney injury (AKI) in this population, according to the study abstract.

Of the total cohort, 28.3% had AKI, and researchers found that in both univariate (OR = 2.46; 95% CI, 2.44-2.48) and multivariate (OR = 1.15; 95% CI, 1.14-1.16) analysis, patients with pulmonary heart disease and diseases of pulmonary circulation faced a significantly higher chance for AKI.

According to the abstract, researchers also observed that AKI in this patient population rose from 23% in 2016 to 27.2% in 2019 (P for trend < .001).

After separating the cohort into those with AKI and those without, researchers found that those with AKI were significantly older (mean age, 71.3 years vs. 68.1 years), and made up of more men (47.7% vs. 42.5%) and Black patients (20.8% vs. 18.4%), with a greater proportion enrolled in Medicare (75.1% vs. 69.6%).

Additionally, patients with AKI were found to have significantly higher rates of hyperlipidemia, obesity, congestive heart failure, renal failure, neurological disorders, complicated diabetes and other comorbidities than those in the non-AKI group, according to researchers.

Patients with vs. without AKI also had worse hospitalization outcomes with significantly higher all-cause mortality (10.2% vs. 3.3%; multivariate OR = 2.53; 95% CI, 2.48-2.58), longer length of stay (mean, 9.2 days vs. 5.8 days) and higher adjusted charges (median, $64,158 vs. $41,910).

“We would suggest future studies, especially prospective and long-term studies, should look into the role of pulmonary hypertension as an independent risk factor for acute kidney injury and subsequent outcomes,” Jain told Healio. “Advanced diagnostics and therapeutics directed toward managing pulmonary hypertension should also consider decreasing the risk of acute kidney injury as one of the endpoints.”

Reference:

Jain A, et al. Chest. 2022;doi:10.1016/j.chest.2022.08.1956.