Generic placeholder image

Current Cardiology Reviews

Editor-in-Chief

ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

Review Article

Effects of Pulmonary Hypertension and Right Ventricular Function in Short and Long-Term Kidney Function

Author(s): Mario Naranjo*, Kevin Bryan Lo, Kenechukwu Mezue and Janani Rangaswami

Volume 15, Issue 1, 2019

Page: [3 - 11] Pages: 9

DOI: 10.2174/1573403X14666181008154215

Price: $65

Abstract

Background: Pulmonary hypertension is not uncommon in patients with renal disease and vice versa; therefore, it influences treatments and outcomes. There is a large body of literature on pulmonary hypertension in patients with kidney disease, its prognostic implications, economic burden, and management strategies. However, the converse, namely the hemodynamic effects of pulmonary hypertension on kidney function (acute and chronic kidney injury) is less studied and described. There is also increasing interest in the effects of pulmonary hypertension on kidney transplant outcomes.

The relationship is a complex phenomenon and multiple body systems and mechanisms are involved in its pathophysiology. Although the definition of pulmonary hypertension has evolved over time with the understanding of multiple interplays between the heart, lungs, kidneys, etc; there is limited evidence to provide a specific treatment strategy when kidneys and lungs are affected at the same time. Nevertheless, available evidence appears to support new therapeutics and highlights the importance of individualized approach.

There is sufficient research showing that the morbidity and mortality from PH are driven by the influence of the pulmonary hemodynamic dysfunction on the kidneys.

Conclusion: This concise review focuses on the effects of pulmonary hypertension on the kidneys, including, the patho-physiological effects of pulmonary hypertension on acute kidney injury, progression of CKD, effects on kidney transplant outcomes, progression of kidney disease in situations such as post LVAD implantation and novel diagnostic indices. We believe a review of this nature will fill in an important gap in understanding the prognostic implication of pulmonary hypertension on renal disease, and help highlight this important component of the cardio-reno-pulmonary axis.

Keywords: Pulmonary hypertension, acute kidney injury, chronic kidney disease, transplantation, pathophysiology, PAH.

Graphical Abstract
[1]
Galiè N, Hoeper MM, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009; 30(20): 2493-537.
[2]
Simonneau G, Gatzoulis MA, Adatia I, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2013; 62(25)(Suppl.): D34-41.
[3]
Hoeper MM, Humbert M, Souza R, et al. A global view of pulmonary hypertension. Lancet Respir Med 2016; 4(4): 306-22.
[4]
Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction: A community-based study. J Am Coll Cardiol 2009; 53: 1119-26.
[5]
Kjaergaard J, Akkan D, Iversen KK, et al. Prognostic importance of pulmonary hypertension in patients with heart failure. Am J Cardiol 2007; 99: 1146-50.
[6]
Ghio S, Gavazzi A, Campana C, et al. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol 2001; 37: 183-8.
[7]
Bursi F, McNallan SM, Redfield MM, et al. Pulmonary pressures and death in heart failure: A community study. J Am Coll Cardiol 2012; 59: 222-3.
[8]
Weitzenblum E, Hirth C, Ducolone A, Mirhom R, Rasaholinjanahary J, Ehrhart M. Prognostic value of pulmonary artery pressure in chronic obstructive pulmonary disease. Thorax 1981; 36: 752-8.
[9]
Chaouat A, Bugnet AS, Kadaoui N, et al. Severe pulmonary hypertension and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005; 172: 189-94.
[10]
Oswald-Mammosser M, Weitzenblum E, Quoix E, et al. Prognostic factors in COPD patients receiving long-term oxygen therapy. Importance of pulmonary artery pressure. Chest 1995; 107: 1193-8.
[11]
Andersen KH, Iversen M, Kjaergaard J, et al. Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease. J Heart Lung Transplant 2012; 31: 373-80.
[12]
Taichman DB, Mandel J. Epidemiology of pulmonary arterial hypertension. Clin Chest Med 2013; 34(4): 619-37.
[13]
Sikachi RR, Sahni S, Mehta D, Agarwal A, Agrawal A. Nationwide trends in inpatient admissions of pulmonary hypertension in the United States from 2000 to 2013. Adv Respir Med 2017; 85(2): 77-86.
[14]
KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2: 8.
[15]
Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8: R204.
[16]
Mehta RL, Kellum JA, Shah SV, et al. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31.
[17]
Levin A, Warnock DG, Mehta RL, et al. Improving outcomes from acute kidney injury: Report of an initiative. Am J Kidney Dis 2007; 50: 1.
[18]
Molitoris BA, Levin A, Warnock DG, et al. Improving outcomes from acute kidney injury. J Am Soc Nephrol 2007; 18: 1992.
[19]
Gajanana D, Mezue K, George J, et al. Effects of pulmonary hypertension on kidney function. Clin Pulm Med 2017; 24: 26-8.
[20]
Firth JF, Raine AE, Ledingham JG. Raised venous pressure: A direct cause of renal sodium retention in edema? Lancet 1998; 1: 1033-5.
[21]
Winton FR. The influence of venous pressure on the isolated mammalian kidney. J Physiol 1931; 72: 49-61.
[22]
Damman K, vaDeursen V, Navis G, et al. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol 2009; 53: 592-8.
[23]
Mullens W, Abrahams Z, Grancis GD, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 2009; 53: 589-96.
[24]
Ronco C, McCullough P, Anker SD, et al. Acute Dialysis Quality Initiative (ADQI) consensus group: Cardio-renal syndromes: Report from the consensus conference of the acute dialysis quality initiative. Eur Heart J 2010; 31: 703-11.
[25]
Sarnak MJ. A patient with heart failure and worsening kidney function. Clin J Am Soc Nephrol 2014; 9: 1790-8.
[26]
Ross EA. Congestive renal failure: The pathophysiology and treatment of renal venous hypertension. J Card Fail 2012; 18: 930-8.
[27]
Laederach K, Weidmann P. Plasma and urinary catecholamines as related to renal function in man. Kidney Int 1987; 31: 107-11.
[28]
Griendling KK, Minieri CA, Ollerensaw JD, et al. Angiotensin II stimulates NADH and NADPH oxidase activity in cultured vascular smooth muscle cells. Circ Res 1994; 74: 1141-8.
[29]
Heymes C, Bendall JK, Ratajczak P, et al. Increased myocardial NADPH oxidase activity in human heart failure. J Am Coll Cardiol 2003; 41: 2164-71.
[30]
Vaziri ND, Dicus M, Ho ND, et al. Oxidative stress and dysregulation of superoxide dismutase and NADPH oxidase in renal insufficiency. Kidney Int 2003; 63: 179-85.
[31]
Ruiz-Ortega M, Ruperez M, Lorenzo O, et al. Angiotensin II regulates the synthesis of proinflammatory cytokines and chemokines in the kidney. Kidney Int 2002; 82: S12-22.
[32]
Remuzzi G, Perico N, Macia M, et al. The role of the reninangiotensin aldosterone system in the progression of chronic kidney disease. Kidney Int 2005; 99(Suppl.): S57-65.
[33]
Mielniczuk LM, Chandy G, Stewart D, et al. Worsening renal function and prognosis in pulmonary hypertension patientshospitalized for right heart failure. Congest Heart Fail 2012; 18: 151-7.
[34]
Navaneethan SD, Wehbe E, Heresi GA, et al. Presence and outcomes of kidney disease in patients with pulmonary hypertension. Clin J Am Soc Nephrol 2014; 9: 855-63.
[35]
Lopez-Sendon J, Coma-Canella I, Gamallo C. Sensitivity and specificity of hemodynamic criteria in the diagnosis of acute right ventricular infarction. Circulation 1981; 64: 515-25.
[36]
O’Rourke RA, Dell’Italia LJ. Diagnosis and management of right ventricular myocardial infarction. Curr Probl Cardiol 2004; 29: 6-47.
[37]
Drazner MH, Robert NB, Fonarow G, et al. Relationship of right and left-sided filling pressures in patients with advanced heart failure: A 14-year multi-institutional analysis. J Heart Lung Transplant 2012; 31: 67-72.
[38]
Drazner MH, Mariella VM, Ayers CR, et al. Relationship of right- to left-sided ventricular filling pressures in advanced heart failure: Insights from the ESCAPE trial. Circ Heart Fail 2013; 6: 264-70.
[39]
Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67(6): 2089-100.
[40]
Navaneethan SD, Roy J, Tao K, et al. Prevalence, predictors, and outcomes of pulmonary hypertension in CKD. J Am Soc Nephrol 2016; 27(3): 877-86.
[41]
Pabst S, Hammerstingl C, Hundt F, et al. Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-study. PLoS One 2012; 7(4): e35310.
[42]
Navaneethan SD, Wehbe E, Heresi GA, et al. Presence and outcomes of kidney disease in patients with pulmonary hypertension. Clin J Am Soc Nephrol 2014; 9(5): 855-63.
[43]
Chakinala MM, Coyne DW, Benza RL, et al. Predicting outcomes in pulmonary arterial hypertension based on estimated glomerular filtration rate. Am J Respir Crit Care Med 2016; 193: A6316.
[44]
Bolignano D, Rastelli S, Agarwal R, et al. Pulmonary hypertension in CKD. Am J Kidney Dis 2013; 61(4): 612-22.
[45]
Giaid A. Nitric oxide and endothelin-1 in pulmonary hypertension. Chest 1998; 114(3): 208S-12S.
[46]
Giaid A, Saleh D. Reduced expression of endothelial nitric oxide synthase in the lungs of patients with pulmonary hypertension. N Engl J Med 1995; 333(4): 214-21.
[47]
Malyszko J. Mechanism of endothelial dysfunction in chronic kidney disease. Clin Chim Acta 2010; 411(19): 1412-20.
[48]
Buemi M, Senatore M, Gallo GC, et al. Pulmonary hypertension and erythropoietin. Kidney Blood Press Res 2007; 30(4): 248-52.
[49]
Akmal M, Barndt RR, Ansari AN, Mohler JG, Massry SG. Excess PTH in CRF induces pulmonary calcification, pulmonary hypertension and right ventricular hypertrophy. Kidney Int 1995; 47(1): 158-63.
[50]
Thambyrajah J, Landray MJ, McGlynn FJ, Jones HJ, Wheeler DC, Townend JN. Abnormalities of endothelial function in patients with predialysis renal failure. Heart 2000; 83(2): 205-9.
[51]
Guazzi M, Borlaug BA. Pulmonary hypertension due to left heart disease. Circulation 2012; 126(8): 975-90.
[52]
Guazzi M. Alveolar gas diffusion abnormalities in heart failure. J Card Fail 2008; 14: 695-702.
[53]
Aronson D, Eitan A, Dragu R, et al. Relationship between reactive pulmonary hypertension and mortality in patients with acute decompensated heart failure. Circ Heart Fail 2011; 4: 644-50.
[54]
Nickel NP, O’Leary JM, Brittain EL, et al. Kidney dysfunction in patients with pulmonary arterial hypertension. Pulmonary Circ 2017; 7(1): 38-54.
[55]
Nootens M, Kaufmann E, Rector T, et al. Neurohormonal activation in patients with right ventricular failure from pulmonary hypertension: Relation to hemodynamic variables and endothelin levels. J Am Coll Cardiol 1995; 26(7): 1581-5.
[56]
de Man FS, Tu L, Handoko ML, et al. Dysregulated renin–angiotensin–aldosterone system contributes to pulmonary arterial hypertension. Am J Respir Crit Care Med 2012; 186(8): 780-9.
[57]
Bolger AP, Sharma R, Li W, et al. Neurohormonal activation and the chronic heart failure syndrome in adults with congenital heart disease. Circulation 2002; 106(1): 92-9.
[58]
Liu C, Jiang XM, Zhang J, et al. Pulmonary artery denervation improves pulmonary arterial hypertension induced right ventricular dysfunction by modulating the local renin-angiotensin-aldosterone system. BMC Cardiovasc Disord 2016; 16(1): 192.
[59]
Rothman AM, Arnold ND, Chang W, et al. Pulmonary artery denervation reduces pulmonary artery pressure and induces histological changes in an acute porcine model of pulmonary hypertension. Circulation 2015; 8(11): e002569.
[60]
Velez-Roa S, Ciarka A, Najem B, Vachiery JL, Naeije R, Van De Borne P. Increased sympathetic nerve activity in pulmonary artery hypertension. Circulation 2004; 110(10): 1308-12.
[61]
Edgley AJ, Kett MM, Anderson WP. Evidence for renal vascular remodeling in angiotensin II-induced hypertension. J Hypertens 2003; 21(7): 1401-6.
[62]
Stevenson KM, Edgley AJ, Bergström G, Worthy K, Kett MM, Anderson WP. Angiotensin II infused intrarenally causes preglomerular vascular changes and hypertension. Hypertension 2000; 36(5): 839-44.
[63]
Chrysostomou A, Pedagogos E, MacGregor L, Becker GJ. Double-blind, placebo-controlled study on the effect of the aldosterone receptor antagonist spironolactone in patients who have persistent proteinuria and are on long-term angiotensin-converting enzyme inhibitor therapy, with or without an angiotensin II receptor blocker. Clin J Am Soc Nephrol 2006; 1(2): 256-62.
[64]
Schrier RW, Bansal S. Pulmonary hypertension, right ventricular failure, and kidney: Different from left ventricular failure? Clin J Am Soc Nephrol 2008; 3(5): 1232-7.
[65]
Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease, Part I. Circulation 2008; 117(11): 1436-48.
[66]
Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II. Circulation 2008; 117(13): 1717-31.
[67]
Matthews JC, McLaughlin V. Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: A detailed review of the pathophysiology, diagnosis, and management. Curr Cardiol Rev 2008; 4(1): 49-59.
[68]
Naeije R, Manes A. The right ventricle in pulmonary arterial hypertension. Eur Respir Rev 2014; 23(134): 476-87.
[69]
Mulder P, Richard V, Derumeaux G, et al. Role of endogenous endothelin in chronic heart failure. Circulation 1997; 96(6): 1976-82.
[70]
Nagaya N, Nishikimi T, Uematsu M, et al. Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation 2000; 102(8): 865-70.
[71]
Damman K, Voors AA, Navis G, van Veldhuisen DJ, Hillege HL. The cardiorenal syndrome in heart failure. Prog Cardiovasc Dis 2011; 54(2): 144-53.
[72]
Husain-Syed F, McCullough PA, Birk HW, et al. Cardio-pulmonary-renal interactions. J Am Coll Cardiol 2015; 65(22): 2433-48.
[73]
Zlotnick DM, Axelrod DA, Chobanian MC, et al. Non-invasive detection of pulmonary hypertension prior to renal transplantation is a predictor of increased risk for early graft dysfunction. Nephrol Dial Transpl 2010; 25(9): 3090-6.
[74]
Issa N, Krowka MJ, Griffin MD, Hickson LJ, Stegall MD, Cosio FG. Pulmonary hypertension is associated with reduced patient survival after kidney transplantation. Transplantation 2008; 86(10): 1384-8.
[75]
Ledsome JR, Kan WO. Reflex changes in hindlimb and renal vascular resistance in response to distention of the isolated pulmonary arteries of the dog. Circ Res 1977; 40(1): 64-72.
[76]
Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2015; 37(1): 67-119.
[77]
Di Lullo L, Floccari F, Rivera R, et al. Pulmonary hypertension and right heart failure in chronic kidney disease: New challenge for 21st-century cardionephrologists. Cardiorenal Med 2013; 3(2): 96-103.
[78]
Sitbon O, Humbert M, Jaïs X, et al. Long-term response to calcium channel blockers in idiopathic pulmonary arterial hypertension. Circulation 2005; 111(23): 3105-11.
[79]
Pulido T, Adzerikho I, Channick RN, et al. Macitentan and morbidity and mortality in pulmonary arterial hypertension. N Engl J Med 2013; 369(9): 809-18.
[80]
Ghofrani HA, Voswinckel R, Reichenberger F, et al. Differences in hemodynamic and oxygenation responses to three different phosphodiesterase-5 inhibitors in patients with pulmonary arterial hypertension: A randomized prospective study. J Am Coll Cardiol 2004; 44(7): 1488-96.
[81]
Ghofrani HA, Galiè N, Grimminger F, et al. Riociguat for the treatment of pulmonary arterial hypertension. N Engl J Med 2013; 369(4): 330-40.
[82]
McLaughlin VV, Channick R, Chin K, et al. Effect of selexipag on morbidity/mortality in pulmonary arterial hypertension: Results of the GRIPHON study. J Am Coll Cardiol 2015; 65(10): A1538.
[83]
Ryerson CJ, Nayar S, Swiston JR, Sin DD. Pharmacotherapy in pulmonary arterial hypertension: A systematic review and meta-analysis. Respir Res 2010; 11(1): 12.
[84]
Vonk-Noordegraaf A, Haddad F, Chin KM, et al. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. J Am Coll Cardiol 2013; 62(25): D22-33.
[85]
Strueber M, Larbalestier R, Jansz P, et al. Results of the post-market registry to evaluate the heartware left ventricular assist system (ReVOLVE). J Heart Lung Transplant 2014; 33(5): 486-91.
[86]
Puhlman M. Continuous-flow left ventricular assist device and the right ventricle. AACN Adv Crit Care 2012; 23(1): 86-90.
[87]
Borgi J, Tsiouris A, Hodari A, et al. Significance of postoperative acute renal failure after continuous-flow left ventricular assist device implantation. Ann Thorac Surg 2013; 95(1): 163-9.
[88]
Tsukashita M, Takayama H, Takeda K, et al. Effect of pulmonary vascular resistance before left ventricular assist device implantation on short- and long-term post-transplant survival. J Thorac Cardiovasc Surg 2015; 150(5): 1352-60.
[89]
Savas S, Kanyilmaz S, Akcay S. Renal transplant improves pulmonary hypertension in patients with end stage renal disease. Multidiscip Respir Med 2011; 6(3): 155-60.
[90]
Navaneethan S, Roy J, Tao K. Prevalence, predictors, and outcomes of pulmonary hypertension in CKD. J Am Soc Nephrol 2016; 27(3): 877-86.
[91]
Yigla M, Nakhoul F, Sabag A, et al. Pulmonary hypertension in patients with end stage renal disease. Chest 2003; 123(5): 1577-82.
[92]
Issa N, Krowka MJ, Griffin MD, et al. Pulmonary hypertension is associated with reduced patient survival after kidney transplantation. Transplantation 2008; 86(10): 1384-8.
[93]
Zlotnick DM, Axelrod DA, Chobanian MC. Non-invasive detection of pulmonary hypertension prior to renal transplantation is a predictor of increased risk for early graft dysfunction. Nephrol Dial Transplant 2010; 25(9): 3090-6.
[94]
Mehra SEJ, Christiano C, Sharma S. Pulmonary hypertension in patients undergoing kidney transplant—a single center experience. Int J Cardiovasc Res 2013; 2(6): 1-3.
[95]
Lai Y-L, Wasse H, Kim WC, et al. Association of pulmonary hypertension at kidney transplant evaluation and subsequent outcomes following transplantation. Am J Transplant 2015. [Abstract].
[96]
Stallworthy EJ, Pilmore HL, Webster MW, et al. Do echocardiographic parameters predict mortality in patients with end-stage renal disease? Transplantation 2013; 95: 1225-32.
[97]
Grupper A, Grupper A, Daly RC, et al. Renal allograft outcome after simultaneous heart and kidney transplantation. Am J Cardiol 2017; 120(3): 494-9.
[98]
Reddy YN, Lunawat D, Abraham G, et al. Progressive pulmonary hypertension: another criterion for expeditious renal transplantation. Saudi J Kidney Dis Transpl 2013; 24(5): 925-9.
[99]
Casas-Aparicio G, Castillo-Martinez L, Orea-Tejeda A, et al. The effect of successful kidney transplantation on ventricular dysfunction and pulmonary hypertension. Transplant Proc 2010; 42: 3524-8.
[100]
Haddad F, Fuh E, Peterson T, et al. Incidence, correlates, and consequences of acute kidney injury in patients with pulmonary arterial hypertension hospitalized with acute right-side heart failure. J Card Fail 2011; 17(7): 533-9.
[101]
Nakhoul F, Yigla M, Gilman R, et al. The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Dial Transplant 2005; 20(8): 1686-92.
[102]
Yigla M, Banderski R, Azzam ZS, et al. Arterio-venous access in end-stage renal disease patients and pulmonary hypertension. Arterio-venous access in end-stage renal disease patients and pulmonary hypertension. Ther Adv Respir Dis 2008; 2(2): 49-53.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy