Pulmonary Hypertension Probability Predicts Dialysis Mortality

Key Takeaways

• In maintenance hemodialysis, intermediate or high echocardiographic probability of PH was associated with higher all-cause mortality.
• Age, left atrial diameter, and RVD also emerged as independent mortality correlates in the overall cohort.
• Mortality correlates differed by vascular access, with age and high PH linked to death in TCC patients and age, intermediate or high PH probability, and RVD linked to death in AVF/AVG patients.
• Survival did not differ between the TCC and AVF/AVG groups.

In maintenance hemodialysis (MHD), mortality modeling is complicated when renal transplantation can occur before death and alter how risk is estimated. Whether echocardiographic probability of pulmonary hypertension (PH) still tracks all-cause mortality under that competing-risk framework, and whether those prognostic patterns differ by vascular access, remained unresolved before investigators assembled this cohort.

A single-center retrospective cohort at the First Affiliated Hospital of Guangxi Medical University enrolled 749 patients treated with MHD between May 2010 and May 2022 in a study published in Clinical Cardiology. All-cause mortality was the primary endpoint, renal transplantation was treated as the competing event, and investigators used a Fine-Gray model to identify independent predictors. Subgroup analyses were performed for tunneled cuffed catheter (TCC) and arteriovenous fistula/graft (AVF/AVG) patients, with right ventricular diameter (RVD) among the echocardiographic variables assessed.

During follow-up, 274 deaths and 64 renal transplantations occurred. In the overall cohort, intermediate or high PH probability, age, left atrial diameter, and RVD independently predicted mortality. Predictor patterns differed by vascular access, with age and high PH predicting death in TCC patients and age, intermediate or high PH, and RVD predicting death in AVF/AVG patients. No survival difference was found between the vascular access groups.

These findings reflect associations from a retrospective single-center cohort rather than causal effects. Because the available source is limited to the abstract, the size of the mortality associations and details of PH category definitions, follow-up duration, and model performance cannot be assessed here. The authors interpreted the subgroup pattern as suggesting that prognostic signals may differ by vascular access even when overall survival does not separate between those groups.

The authors concluded that PH severity, age, and markers of cardiac structural remodeling emerged as independent mortality correlates in MHD, and that the pattern of predictors was not identical across vascular access groups.

Clinician Questions

Does echocardiographic pulmonary hypertension probability predict mortality in maintenance hemodialysis?

In maintenance hemodialysis patients, intermediate or high echocardiographic probability of pulmonary hypertension independently predicted all-cause mortality in the competing-risk analysis.

How was renal transplantation handled when mortality was analyzed in maintenance hemodialysis?

Investigators studied 749 maintenance hemodialysis patients in a single-center retrospective cohort from May 2010 to May 2022, used all-cause mortality as the primary endpoint, and treated renal transplantation as the competing event in a Fine-Gray model.

Were mortality predictors the same in tunneled catheter and AV fistula or graft hemodialysis patients?

Predictor patterns differed by vascular access: among tunneled cuffed catheter patients, age and high pulmonary hypertension predicted death, whereas among arteriovenous fistula/graft patients, age, intermediate/high pulmonary hypertension, and right ventricular diameter predicted death. No survival difference was found between the vascular access groups.