Table 1.
Studies investigating renal function and RHC-confirmed PH
| Study | Population | Key findings |
|---|---|---|
| Leuchte et al. 2007 (18) | 118 patients with PH undergoing RHC, excluding those with left-heart disease or ESRD on haemodialysis | eGFR <60 mL/min/1.73 m2 has a prevalence of 19% and is associated with increased mortality. NT-proBNP lost correlation with haemodynamics in patients with renal impairment. |
| Shah et al. 2008 (19) | 500 patients with PAH (1982–2006). Excluded patients without baseline serum creatinine or ESRD. Only 460 patients had baseline RHC | Serum creatinine ≥1 mg/dL was independently associated with increased mortality. The association between renal function and death was most prominent in patients with RAP ≤10 mmHg. |
| Pabst et al. 2012 (20) | 62 patients with CKD stage 4 or 5, with or without haemodialysis, presenting with unexplained dyspnoea. Excluded patients with left ventricular ejection fraction <50%, significant valvular disease and severe lung disease | Post-capillary PH prevalence: - 65% in dialysis - 71% in non-dialysis Pre-capillary PH prevalence: - 13% in dialysis - 6% in non-dialysis All cases of pre-capillary PH in dialysis were unmasked only after haemodialysis. |
| Navaneethan et al. 2014 (13) | 1088 patients with mPAP ≥25 mmHg. Excluded patients on chronic dialysis or with kidney transplants | 36% of the PH cohort had eGFR <60 mL/min/1.73 m2 Lower eGFR was independently associated with higher allcause mortality. |
| O’Leary et al. 2017 (21) | 4635 patients undergoing RHC, with a baseline eGFR measurement | In patients with CKD, 68% had PH. Post-capillary PH was the most frequent (76% of all PH). CKD severity and PH were associated with increased mortality. |
| Bitker et al. 2018 (22) | 179 patients with RHC-confirmed PAH | 29% had CKD (eGFR <60 mL/min/1.73 m2). CKD was independently associated with increased mortality. Lower CI and higher RAP were key haemodynamic determinants of eGFR decline during follow-up. |
| Chakinala et al. 2018 (23) | 2368 PAH patients from the REVEAL registry with baseline and follow-up eGFR | A ≥10% decline in eGFR over 1 year independently predicted higher risk of death and clinical worsening. Lower baseline eGFR correlated significantly with higher mean RAP and lower CO. |
| Nickel et al. 2019 (24) | 283 patients with PAH, with measured urinary ACR | Albuminuria (ACR >30 mg/g) was present in 20.1% of patients and associated with higher mortality. Albuminuria did not correlate with right heart haemodynamics. |
| Edmonston et al. 2020 (25) | 12,618 patients with RHC (all indications), with baseline serum creatinine | 74% of patients with CKD had PH, predominantly isolated post-capillary (39.0%) or CpcPH (38.3%). CpcPH was associated with the highest mortality risk among patients with CKD. |
| Meservey et al. 2025 (26) | 6694 patients from 18 phase III clinical trials in PAH and CTEPH | 13.5% had a baseline eGFR <60 mL/min/1.73 m2. Lower eGFR correlated with higher mean RAP and lower CI. PH therapy resulted in a minimal but statistically significant improvement in eGFR (+2.0 mL/min/1.73 m2 at 12–16 weeks). |
1 ACR, albumin to creatinine ratio; ADMA, asymmetric dimethylarginine; CI, cardiac index; CKD, chronic kidney disease; CO, cardiac output; CpcPH, combined pre- and post-capillary PH; CTEPH, chronic thromboembolic pulmonary hypertension; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease; NT-proBNP, N-terminal pro B-type natriuretic peptide; PH, pulmonary hypertension; RAP, right atrial pressure; REVEAL, Registry to Evaluate Early and Long-term PAH Disease Management; RHC,
Figure 1.
Pathophysiological mechanisms of pulmonary hypertension in chronic kidney disease. ADMA, asymmetric dimethylarginine; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; ET-1, endothelin-1; FGF-23, fibroblast growth factor 23; ILD, interstitial lung disease; mPAP, mean pulmonary artery pressure; NO, nitric oxide; PAWP, pulmonary artery wedge pressure; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; RAP, right atrial pressure; RAAS, renin-angiotensin-aldosterone system.