Prevalence and factors associated with Pulmonary Arterial Hypertension on maintenance Hemodialysis Patients in Kinshasa, the Democratic Republic of the Congo

Abstract

Abstract Background: Cardiovascular diseases in particular Pulmonary arterial hypertension (PAH) is associed a high morbi-mortality in chronic hemodialysis, but it’s magnitude remains paradoxically unknown in sub-Saharan Africa. The aim of this study was to evaluate the prevalence of PAH and associated factors in chronic hemodialysis patients. Patients and method: In a cross-sectional study, patients treated with HD for at least 6 months in 4 hemodialysis centers were examined. PAH was defined as estimated systolic pulmonary arterial pressure (sPAP) ≥ 35 mmHg using transthoracic Doppler echocardiography performed 24 hours after the session. Results: A total of 85 HD patients were included. Their average age was 54.6 ± 14.3 years. 57 patients (67.1%) were male. Mean duration of HD was 13.3 ± 11 months. With reference to vascular access, 12 (14.1%), 29 (34.1%) and 44 (51.8%) patients had AVF, tunneled cuff and temporary catheter, respectively. The underlying cause of ESRD was diabetes in 30 patients (35.3%). The prevalence of PAH was 29.4%. In multivariate analysis, no secure healthcare funding (adjusted OR 5, 95% CI [1.24-8.27]), hyponatremia (adjusted OR 2, 95% CI [1.61-10.01]), arrhythmia (aOR 3, 95% CI [1.06 -5.85]), vascular access change (aOR 4, 95% CI [1.12-6.23]) and diastolic dysfunction (aOR 5, 95% CI [1.35-9.57] were independently associated with PAH. Conclusion: One third of hemodialysis patients exhibit PAH, which is associated with diastolic dysfunction and arrhythmia. Therefore, early detection and control of PAH and associated factors may help to tackle PAH associated morbidity and mortality in maintenance hemodialysis patients. Keywords: Pulmonary hypertension, Hemodialysis, Systolic pulmonary arterial pressure, Cardiovascular disease.