Prevalence and Associated Echocardiographic Findings of Pulmonary Hypertension in Chronic Kidney Disease: A Cross-Sectional Study

Background: Pulmonary hypertension (PH) is an increasingly recognized cardiovascular complication in chronic kidney disease (CKD), yet the echocardiographic features associated with its presence remain insufficiently characterized in routine nephrology practice. This study determined the prevalence of echocardiographically defined PH in CKD and examined echocardiographic variables associated with its presence. Methodology: This cross-sectional study included 120 adults with stages 3-5 CKD, including both conservatively managed patients and those receiving maintenance hemodialysis, evaluated between November 2024 and December 2025. PH was defined echocardiographically as an estimated pulmonary artery systolic pressure (PASP) >35 mmHg. Clinical, renal, and echocardiographic variables were compared between patients with and without PH. Because the estimated PASP was derived from tricuspid regurgitation velocity (TRV) and estimated right atrial pressure (RAP), these variables were considered definitional components of PH classification rather than independent associated findings. Exploratory analyses focused on non-definitional clinical and echocardiographic variables. Results: PH was present in 68 (56.7%) patients, while 52 (43.3%) had no PH. Mild PH was observed in 21 (17.5%), moderate PH in 25 (20.8%), and severe PH in 22 (18.3%). Patients with PH more frequently had stage 5 CKD (40, 58.8%, vs. 14, 26.9%), dialysis dependence (38, 55.9%, vs. 16, 30.8%), volume overload (41, 60.3%, vs. 16, 30.8%), and diastolic dysfunction (53, 77.9%, vs. 22, 42.3%). Among non-definitional echocardiographic findings, patients with PH had lower tricuspid annular plane systolic excursion, larger right atrial diameter, and more frequent diastolic dysfunction. TRV and estimated RAP were not interpreted as independent associated variables because they contributed directly to PASP estimation. Conclusions: PH was present in 68 of 120 patients with CKD, corresponding to a prevalence of 56.7%. Because PH was classified using estimated PASP derived from TRV and estimated RAP, these variables were not interpreted as independent echocardiographic correlates. Non-definitional echocardiographic findings associated with PH included lower tricuspid annular plane systolic excursion, larger right atrial size, and more frequent diastolic dysfunction. These findings support careful multiparameter echocardiographic assessment in CKD but should be interpreted as associative rather than predictive evidence.