Pulmonary Hypertension Subtypes and Mortality in CKD.
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2019-11-12
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RATIONALE & OBJECTIVE:Pulmonary hypertension (PH) contributes to cardiovascular disease and mortality in patients with chronic kidney disease (CKD), but the pathophysiology is mostly unknown. This study sought to estimate the prevalence and consequences of PH subtypes in the setting of CKD. STUDY DESIGN:Observational retrospective cohort study. SETTING & PARTICIPANTS:We examined 12,618 patients with a right heart catheterization in the Duke Databank for Cardiovascular Disease from January 1, 2000, to December 31, 2014. EXPOSURES:Baseline kidney function stratified by CKD glomerular filtration rate category and PH subtype. OUTCOMES:All-cause mortality. ANALYTICAL APPROACH:Multivariable Cox proportional hazards analysis. RESULTS:In this cohort, 73.4% of patients with CKD had PH, compared with 56.9% of patients without CKD. Isolated postcapillary PH (39.0%) and combined pre- and postcapillary PH (38.3%) were the most common PH subtypes in CKD. Conversely, precapillary PH was the most common subtype in the non-CKD cohort (35.9%). The relationships between mean pulmonary artery pressure, pulmonary capillary wedge pressure, and right atrial pressure with mortality were similar in both the CKD and non-CKD cohorts. Compared with those without PH, precapillary PH conferred the highest mortality risk among patients without CKD (HR, 2.27; 95% CI, 2.00-2.57). By contrast, in those with CKD, combined pre- and postcapillary PH was associated with the highest risk for mortality in CKD in adjusted analyses (compared with no PH, HRs of 1.89 [95% CI, 1.57-2.28], 1.87 [95% CI, 1.52-2.31], 2.13 [95% CI, 1.52-2.97], and 1.63 [95% CI, 1.12-2.36] for glomerular filtration rate categories G3a, G3b, G4, and G5/G5D). LIMITATIONS:The cohort referred for right heart catheterization may not be generalizable to the general population. Serum creatinine data in the 6 months preceding catheterization may not reflect true baseline CKD. Observational design precludes assumptions of causality. CONCLUSIONS:In patients with CKD referred for right heart catheterization, PH is common and associated with poor survival. Combined pre- and postcapillary PH was common and portended the worst survival for patients with CKD.
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Edmonston, Daniel L, Kishan S Parikh, Sudarshan Rajagopal, Linda K Shaw, Dennis Abraham, Alexander Grabner, Matthew A Sparks, Myles Wolf, et al. (2019). Pulmonary Hypertension Subtypes and Mortality in CKD. American journal of kidney diseases : the official journal of the National Kidney Foundation. 10.1053/j.ajkd.2019.08.027 Retrieved from https://hdl.handle.net/10161/20057.
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Scholars@Duke
Daniel Len Edmonston
My primary research focus lies at the intersection of kidney and cardiovascular disease including pulmonary hypertension, heart failure, and atherosclerotic disease in patients with chronic kidney disease.
Kishan S Parikh
Duke University Medical Center
Duke Clinical Research Institute
Dennis M Abraham
Matthew A. Sparks
I serve as the Program Director for the Nephrology Fellowship Program. My goal is to work with each fellow to ensure they develop a successful career in whatever direction they choose. I am the lead for the newly established Society for Early Education Scholars (SEEDS) in the Department of Medicine. The SEEDS Program is a year-long mentored education program designed for fellows planning careers as clinician educators or education scholars.
Nephrology Fellowship Program
My interest is in finding ways to promote medical education. My focus is on leveraging social media to enhance learning in nephrology. I serve as the associate director for the Nephrology Social Media Collective (NSMC) internship and member of the board of directors of nephrology journal club (NephJC), a non-profit organization dedicated to enhancing free online medical education in nephrology. I am also co-founder and advisory board member of the first nephrology blog associated with a journal- AJKD blog, the official blog of the American Journal of Kidney Diseases. Co-creator of the popular educational project NephMadness. Past deputy editor of Renal Fellow Network where I continue to remain as faculty lead. I am currently a member of the Nephrology Board of the American Board of Internal Medicine, the Scientific and Clinical Education Lifelong learning Committee Chair, Kidney in Cardiovascular Disease Council of the American Heart Association and am a fellow of the American Society of Nephrology, the American Heart Association, and the National Kidney Foundation.
Listen to my podcast "The Nephron Segment"
Myles Selig Wolf
The focus of my research is disordered mineral metabolism across the spectrum of chronic kidney disease, including dialysis, kidney transplantation and earlier stages.
My research has been published in leading general medicine and subspecialty journals, including the New England Journal of Medicine, JAMA, the Journal of Clinical Investigation, Circulation, Cell Metabolism, Journal of the American Society of Nephrology, and Kidney International, among others.
My primary contributions have been in the area of hormonal regulation of phosphate homeostasis. I have helped to characterize the physiological role of fibroblast growth factor 23 in health and in chronic kidney disease, and the impact of elevated fibroblast growth factor 23 levels on adverse clinical outcomes in patients with kidney disease.
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