Pulmonary hypertension in patients with chronic kidney disease: the multifaceted pathogenesis

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Abstract

Pulmonary hypertension (PH) is a group of diseases characterized by progressive increase in pulmonary vascular resistance, which leads to development of right ventricular failure and an unfavorable prognosis of life. There are 5 groups in the clinical classification, mainly based on the cause and pathophysiological changes in the pulmonary vessels. PH in patients with chronic kidney disease (CKD) is a common and severe complication and belongs to group 5 in the classification. PH is diagnosed in 21 % of patients with CKD who are not on dialysis and in 50–60 % of patients with end-stage kidney disease. On the other hand, development of CKD in patients with pulmonary hypertension doubles the risk of mortality, and with end-stage CKD it triples. In most patients in this group, the main causes of PH are volume overload and left ventricular dysfunction. However, many other factors both enhance and offset the effect of volume overload on PH. These factors include the effects of vascular access for dialysis, anemia, respiratory disorders and hypoxemia, inflammation, and changes in mineral metabolism. In addition, CKD can directly affect the blood vessels of the lungs through the action of nitric oxide, endothelin-1, prostacyclin. Catheterization of the right heart, as the basis for the diagnosis of PH, provides insight into the potential hemodynamic profile of pulmonary hypertension associated with CKD. The article summarizes current data undelying new theoretical mechanisms of pathogenesis of PH associated with CKD.

About the authors

Darya Yu. Andriyashkina

N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Author for correspondence.
Email: andryashkina.darya@yandex.ru
ORCID iD: 0000-0001-8266-6022
Russian Federation, 1 Ostrovityanova St., Moscow 117513

V. V. Podoprigora

N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: andryashkina.darya@yandex.ru
ORCID iD: 0009-0005-6472-300X
Russian Federation, 1 Ostrovityanova St., Moscow 117513

S. S. Kamyshev

N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: andryashkina.darya@yandex.ru
ORCID iD: 0009-0001-4162-6013
Russian Federation, 1 Ostrovityanova St., Moscow 117513

Alesya A. Klimenko

N. I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: andryashkina.darya@yandex.ru
ORCID iD: 0000-0002-7410-9784

MD, PhD, Associate Professor, Head of the Department of Acad. A.I. Nesterov of Faculty Therapy

Russian Federation, 1 Ostrovityanova St., Moscow 117513

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