In pulmonary hypertension, there is a paucity of evidence identifying hemodynamic correlates of renal function (PH). For a study, researchers wanted to determine if there was a link between renal function in PH and traditional and new hemodynamic markers such as the pulmonary artery pulsatility index (PAPi) and the right atrial to pulmonary capillary wedge pressure (RA: PCWP) ratio.
At Einstein Medical Center in Philadelphia, they conducted a retrospective analysis of adult patients with PH identified by right-heart catheterization (RHC) between January 2007 and October 2012. Patients with end-stage renal disease were not allowed to participate. The researchers looked at pulmonary artery pulse pressure, RA: PCWP, PAPi (pulmonary artery pulse pressure/RA), and conventional RHC characteristics. There were 171 patients in the final group. The median age was 59±13 years, and 52% of the participants were men with a mean pulmonary arterial pressure of 39±8 mm Hg.
From the time of admission to the time of RHC, 68 patients exhibited worsening creatinine. Patients with a RA:PCWP greater than 0.86 had substantially higher RHC creatinine (2.2±1.0 vs. 1.7±1.7 mg/dL, P=0.01) and deteriorating creatinine (+0.9±0.9 vs. +0.4±0.3 mg/dL, P=0.03). The study’s main conclusion is that decreasing renal function from the time of admission to RHC was substantially associated with high RA: PCWP and poor ejection fraction in PH (all groups). Other novel and traditional hemodynamic indicators, such as higher right atrial pressure and PAPi, were shown to be less effective predictors of decreasing renal function than high RA: PCWP.