A new study has found that parameters related to volume overload and cardiac transthoracic echocardiography (TTE) can be predictors of systolic pulmonary artery pressure (sPAP) in patients with pulmonary arterial hypertension (PAH) who are undergoing continuous ambulatory peritoneal dialysis (CAPD). The study was published in Therapeutic Apheresis and Dialysis.

“It is speculated that chronic volume overload-induced subsequent cardiac remodeling plays a major role in the pathogenesis of PAH,” the authors wrote. “In the present study, we aimed to describe the prevalence of PAH among patients undergoing CAPD and to evaluate the possible variables that can distinguish patients with PAH from those without it.”

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The research team conducted a cross-sectional study on 43 adult patients undergoing CAPD at a single center between February and June of 2020. The patients were divided into 2 groups: those with PAH and those without it. After draining PD fluids, cardiography and bioimpedance analyses were conducted on all participants, followed by TTE.

Participant data, including demographics, clinical data, TTE findings, and bioimpedance parameters were compared. An sPAP greater than 35 mmHg was considered pulmonary hypertension.

The results showed that echocardiographic findings could be predictive of PAH in patients undergoing CAPD. Patients with PAH in the study had elevated TTE findings, specifically left atrial diameter, left atrial volume, and diastolic dysfunction. Furthermore, diabetes, left ventricular hypertension, and a greater inferior vena cava expiratory diameter were significantly more prevalent among patients with PAH than among those without it.

The authors speculate that alongside other factors, PAH develops in patients with CAPD based on underlying volume overload and its associated cardiac anomalies, such as left atrial diameter and diastolic dysfunction.

Reference

Nekooeian M, Jahromi SE, Masjedi F, et al. The significance of volume overload in the development of pulmonary arterial hypertension in continuous ambulatory peritoneal dialysis patients. Ther Apher Dial. Published online December 29, 2022. doi: 10.1111/1744-9987.13965