An echo cardiographic evaluation of pulmonary pressures in hemodialysis patients at Kenyatta National Hospital, Nairobi, Kenya

Abstract

Background. A high prevalence of pulmonary hypertension (PH) in patients with end-stage renal disease (ESRD) has been noted. In these patients, PH increases morbidity and mortality and worsens prognosis post-renal transplant. Its aetiopathogenesis may be multifactorial, involving the process of hemodialysis itself.

Objective. To determine the prevalence of PH among patients with ESRD undergoing hemodialysis at Kenyatta National Hospital (KNH), using Doppler echocardiography.

Design. 117 patients were consecutively recruited into this cross-sectional study. Medical history was used to exclude patients with possible PH of known aetiology. Patients were examined for features of fluid overload. Each patient then underwent hemodialysis followed by echocardiography within two hours. Hemoglobin was measured.

Setting. The Renal Unit, KNH, a tertiary hospital in Nairobi

Subjects. Patients undergoing regular hemodialysis within the renal unit, thirteen years and above, who gave written informed consent or assent.

Results. 63.2% of the participants were male. Mean age was 44 years. Prevalence of PH among ESRD patients was 32.5%, with a median PASP of 47.3mmHg and a range of 36.1–79 mmHg. A strong association between PH and EF of less than 50%, as a marker of LV dysfunction, was demonstrated.

Conclusion. The prevalence of PH among end-stage renal disease patients was high. This suggests an indication for routinely screening hemodialysis patients for PH.