The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press69010.17650/1818-8338-2025-19-4-K760REVIEWОБЗОРReview ArticlePulmonary hypertension in patients with chronic kidney disease: the multifaceted pathogenesisЛегочная гипертензия у пациентов с хронической болезнью почек: многогранность патогенезаhttps://orcid.org/0000-0001-8266-6022AndriyashkinaDarya Yu.АндрияшкинаДарья Юрьевна
Russian Federation
andryashkina.darya@yandex.ruhttps://orcid.org/0009-0005-6472-300XPodoprigoraV. V.ПодопригораВ. В.
Russian Federation
andryashkina.darya@yandex.ruhttps://orcid.org/0009-0001-4162-6013KamyshevS. S.КамышевС. С.
Russian Federation
andryashkina.darya@yandex.ruhttps://orcid.org/0000-0002-7410-9784KlimenkoAlesya A.КлименкоАлеся Александровна
Russian Federation

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

д.м.н., доцент, заведующая кафедрой факультетской терапии им. акад. А.И. Нестерова Института клинической медицины

andryashkina.darya@yandex.ruN. I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава России1703202619443521603202616032026Copyright ©; 2026, Andriyashkina D.Y., Podoprigora V.V., Kamyshev S.S., Klimenko A.А.Copyright ©; 2026, Андрияшкина Д.Ю., Подопригора В.В., Камышев С.С., Клименко А.А.2026Andriyashkina D.Y., Podoprigora V.V., Kamyshev S.S., Klimenko A.А.Андрияшкина Д.Ю., Подопригора В.В., Камышев С.С., Клименко А.А.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/690

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.

Легочная гипертензия (ЛГ) – группа заболеваний, характеризующихся прогрессирующим повышением легочного сосудистого сопротивления, которое приводит к развитию правожелудочковой сердечной недостаточности и неблагоприятному прогнозу жизни. В клинической классификации выделяют 5 групп ЛГ, в основном опираясь на причину возникновения и патофизиологические изменения легочных сосудов. ЛГ у пациентов с хронической болезнью почек (ХБП) является распространенным и тяжелым осложнением и в классификации относится к 5-й группе. ЛГ диагностируется у 21 % пациентов с ХБП, не находящихся на диализе, и у 50–60 % пациентов с терминальной стадией заболевания почек. В случае развития ХБП у пациентов с ЛГ риск смертности удваивается, в терминальной стадии ХБП – утраивается. У большинства пациентов в этой группе основными причинами ЛГ являются объемная перегрузка и дисфункция левого желудочка. Однако множество других факторов как усиливают, так и нивелируют влияние объемной перегрузки на ЛГ. Эти факторы включают в себя влияние сосудистого доступа для диализа, анемию, нарушения дыхания и гипоксемию, воспаление и изменение минерального обмена. Кроме того, ХБП может непосредственно влиять на сосуды легких посредством действия оксида азота, эндотелина-1 и простациклина. Катетеризация правых отделов сердца как основа диагностики ЛГ позволяет получить представление о потенциальном гемодинамическом профиле ЛГ, связанной с ХБП. В статье обобщены современные данные, представляющие новые теоретические механизмы патогенеза ЛГ, ассоциированной с ХБП.

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