Hemodynamic response to inhaled nitric oxide in patients with pulmonary hypertension and chronic kidney disease: A retrospective cohort study
Abstract Pulmonary hypertension (PH) associated with chronic kidney disease (CKD) (PH‐CKD) affects approximately 20%–40% of CKD patients and is associated with increased morbidity and mortality. PH and CKD are both pathophysiologically associated with nitric oxide (NO) deficiency. The NO pathway, an...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-01-01
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| Series: | Pulmonary Circulation |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/pul2.12341 |
| _version_ | 1797236697690275840 |
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| author | Kathryn T. delValle Michael J. Krowka Carrie A. Schinstock Karl A. Nath Charles D. Burger Yogesh N. Reddy Robert P. Frantz Y. S. Prakash Hilary M. DuBrock |
| author_facet | Kathryn T. delValle Michael J. Krowka Carrie A. Schinstock Karl A. Nath Charles D. Burger Yogesh N. Reddy Robert P. Frantz Y. S. Prakash Hilary M. DuBrock |
| author_sort | Kathryn T. delValle |
| collection | DOAJ |
| description | Abstract Pulmonary hypertension (PH) associated with chronic kidney disease (CKD) (PH‐CKD) affects approximately 20%–40% of CKD patients and is associated with increased morbidity and mortality. PH and CKD are both pathophysiologically associated with nitric oxide (NO) deficiency. The NO pathway, an important therapeutic domain in pulmonary arterial hypertension (PAH), is an intriguing but unexplored target in PH‐CKD. We sought to improve understanding of the clinical significance of the NO pathway in patients with PH‐CKD by assessing the hemodynamic response to inhaled NO (iNO) during right heart catheterization (RHC). In this retrospective cohort study, patients with diagnosis codes of PH and stage IV/V CKD or end‐stage renal disease and estimated glomerular filtration rate < 60 mL/min/body surface area who underwent RHC and hemodynamic drug study between July 2011 and June 2021 were eligible. Patients with mean pulmonary artery pressure (mPAP) > 20 mmHg and pulmonary vascular resistance (PVR) > 3 Wood units were included. The final cohort included 37 patients (45.9% female, mean age 72.5 ± 9.7 years). A total of 56.7% of the cohort (21/37) had precapillary PH, while 43.2% (16/37) had combined precapillary postcapillary PH (Cpc‐PH). Median survival was 3.1 years after RHC. iNO was associated with a significant decrease in both mPAP and PVR. Hemodynamic changes in mPAP and PVR were similar in precapillary and Cpc‐PH groups. Among a small subset (n = 14) who were subsequently treated with PAH‐targeted therapy, treatment response was mixed and did not reveal significant benefit. Further studies are warranted to better define the potential role of PAH therapy in PH‐CKD. |
| first_indexed | 2024-04-24T17:07:59Z |
| format | Article |
| id | doaj.art-13ff566423274794ba828f545f932864 |
| institution | Directory Open Access Journal |
| issn | 2045-8940 |
| language | English |
| last_indexed | 2024-04-24T17:07:59Z |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj.art-13ff566423274794ba828f545f9328642024-03-28T19:28:30ZengWileyPulmonary Circulation2045-89402024-01-01141n/an/a10.1002/pul2.12341Hemodynamic response to inhaled nitric oxide in patients with pulmonary hypertension and chronic kidney disease: A retrospective cohort studyKathryn T. delValle0Michael J. Krowka1Carrie A. Schinstock2Karl A. Nath3Charles D. Burger4Yogesh N. Reddy5Robert P. Frantz6Y. S. Prakash7Hilary M. DuBrock8Division of Pulmonary and Critical Care Medicine Mayo Clinic Rochester Minnesota USADivision of Pulmonary and Critical Care Medicine Mayo Clinic Rochester Minnesota USADivision of Nephrology and Hypertension Mayo Clinic Rochester Minnesota USADivision of Nephrology and Hypertension Mayo Clinic Rochester Minnesota USADivision of Pulmonary and Critical Care Medicine Mayo Clinic Jacksonville Florida USADepartment of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USADepartment of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USADepartment of Anesthesia Mayo Clinic Rochester Minnesota USADivision of Pulmonary and Critical Care Medicine Mayo Clinic Rochester Minnesota USAAbstract Pulmonary hypertension (PH) associated with chronic kidney disease (CKD) (PH‐CKD) affects approximately 20%–40% of CKD patients and is associated with increased morbidity and mortality. PH and CKD are both pathophysiologically associated with nitric oxide (NO) deficiency. The NO pathway, an important therapeutic domain in pulmonary arterial hypertension (PAH), is an intriguing but unexplored target in PH‐CKD. We sought to improve understanding of the clinical significance of the NO pathway in patients with PH‐CKD by assessing the hemodynamic response to inhaled NO (iNO) during right heart catheterization (RHC). In this retrospective cohort study, patients with diagnosis codes of PH and stage IV/V CKD or end‐stage renal disease and estimated glomerular filtration rate < 60 mL/min/body surface area who underwent RHC and hemodynamic drug study between July 2011 and June 2021 were eligible. Patients with mean pulmonary artery pressure (mPAP) > 20 mmHg and pulmonary vascular resistance (PVR) > 3 Wood units were included. The final cohort included 37 patients (45.9% female, mean age 72.5 ± 9.7 years). A total of 56.7% of the cohort (21/37) had precapillary PH, while 43.2% (16/37) had combined precapillary postcapillary PH (Cpc‐PH). Median survival was 3.1 years after RHC. iNO was associated with a significant decrease in both mPAP and PVR. Hemodynamic changes in mPAP and PVR were similar in precapillary and Cpc‐PH groups. Among a small subset (n = 14) who were subsequently treated with PAH‐targeted therapy, treatment response was mixed and did not reveal significant benefit. Further studies are warranted to better define the potential role of PAH therapy in PH‐CKD.https://doi.org/10.1002/pul2.12341combined precapillary postcapillary PHprecapillary PHright heart catheterization |
| spellingShingle | Kathryn T. delValle Michael J. Krowka Carrie A. Schinstock Karl A. Nath Charles D. Burger Yogesh N. Reddy Robert P. Frantz Y. S. Prakash Hilary M. DuBrock Hemodynamic response to inhaled nitric oxide in patients with pulmonary hypertension and chronic kidney disease: A retrospective cohort study Pulmonary Circulation combined precapillary postcapillary PH precapillary PH right heart catheterization |
| title | Hemodynamic response to inhaled nitric oxide in patients with pulmonary hypertension and chronic kidney disease: A retrospective cohort study |
| title_full | Hemodynamic response to inhaled nitric oxide in patients with pulmonary hypertension and chronic kidney disease: A retrospective cohort study |
| title_fullStr | Hemodynamic response to inhaled nitric oxide in patients with pulmonary hypertension and chronic kidney disease: A retrospective cohort study |
| title_full_unstemmed | Hemodynamic response to inhaled nitric oxide in patients with pulmonary hypertension and chronic kidney disease: A retrospective cohort study |
| title_short | Hemodynamic response to inhaled nitric oxide in patients with pulmonary hypertension and chronic kidney disease: A retrospective cohort study |
| title_sort | hemodynamic response to inhaled nitric oxide in patients with pulmonary hypertension and chronic kidney disease a retrospective cohort study |
| topic | combined precapillary postcapillary PH precapillary PH right heart catheterization |
| url | https://doi.org/10.1002/pul2.12341 |
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