Prevalence and risk factors of pulmonary hypertension in maintenance hemodialysis patients based on echocardiography

This study aims to use echocardiography to explore the prevalence of pulmonary hypertension (PH) in maintenance hemodialysis patients with different vascular accesses and analyze the risk factors for combined PH. A cross-sectional analysis was conducted on 757 end-stage renal disease patients receiving maintenance hemodialysis. Patients were categorized by the type of access used during echocardiographic examination: central vein catheter (CVC) and autogenous arteriovenous fistula (AVF)/arteriovenous graft (AVG). They were further grouped by tricuspid regurgitation velocity to determine PH prevalence. Multinomial logistic regression analysis evaluated the relevant risk factors. (1) Among maintenance hemodialysis patients, 39.23% had a moderate to high likelihood of PH; 248 patients (32.76%) had diastolic dysfunction, 184 patients (24.31%) had pericardial effusion, 381 patients (50.33%) had left ventricular hypertrophy, and 268 patients (35.40%) had aortic regurgitation. Diastolic dysfunction may indicate early heart failure and PH progression. (2) In the CVC group, 62 patients (24.22%) had moderate PH, and 9 (3.52%) had severe PH. Left atrium diameter (OR = 1.086, 95% CI 1.024-1.151, P = .006 and OR = 1.123, 95% CI 1.001-1.260, P = .048) showed statistical significance in moderate and severe PH groups, respectively. Right ventricular end-systolic diameter (RVDS) (OR = 1.519, 95% CI 1.151-2.005, P = .003) was significant in the severe PH group. (3) In the AVF/AVG group, 158 patients (31.54%) had moderate PH, and 68 (13.57%) had severe PH. RVDS (OR = 1.183, 95% CI 1.078-1.298, P < .001 and OR = 1.607, 95% CI 1.413-1.829, P < .001) showed significance in moderate and severe PH groups. Left atrium diameter (OR = 1.060, 95% CI 1.004-1.120, P = .035) showed significance in the severe PH group. The incidence of PH in maintenance hemodialysis patients is high and is closely related to volume overload, vascular access type, and right ventricular enlargement. For patients with right ventricular dilation (e.g., RVDS > 25 mm) or moderate to severe PH, careful evaluation of the benefit-risk ratio for AVF/AVG should be conducted. In selected high-risk cases, alternative access such as CVC may be appropriate. Prospective studies are needed to further compare the long-term effects of different access types on PH progression.