Pulmonary hypertension predicts adverse outcomes in renal patients: a systematic review and Meta-Analysis

In the general population and in heart disease, pulmonary hypertension (PH) is a strong and independent risk factor for mortality and adverse cardiovascular outcomes. We performed a systematic review and meta-analysis of longitudinal cohort studies of individuals with chronic kidney disease (CKD) of any-stage (also including end-stage kidney disease -ESKD- and kidney transplantation) stratified according to presence/absence of PH. 18 eligible studies (10740 participants) were retrieved. PH had an overall pooled prevalence (PP) of 33% (95% CI 28-42) and portended a higher risk of all-cause mortality (RR 2.08; 1.06-4.08), cardiovascular mortality (RR 3.77; 2.46-5.78) and non-fatal cardiovascular events (RR 1.60; 1.28-1.99). PH is highly prevalent in CKD and ESKD and may represent a novel factor for mortality and cardiovascular risk stratification, particularly in selected sub-categories. Future, high quality research is required to confirm the need for clinical attention on PH in the CKD setting.