Association of Estimated Plasma Volume Status With Invasive Hemodynamics and Adverse Clinical Outcomes in Patients With Pulmonary Hypertension and Chronic Kidney Disease.

Abstract

Identifying noninvasive measures to assess intravascular volume status and risk stratify patients with pulmonary hypertension (PH) and chronic kidney disease (CKD) is needed. We assessed the predictive value of estimated plasma volume status (ePVS) using the Strauss-derived Duarte formula in PH-CKD patients. This single-center retrospective cohort analysis included patients with PH and CKD Stage 3b (CKD3b), Stage 4 (CKD4), or Stage 5 (CKD5) who underwent right heart catheterization from 2018 to 2023. Patients were categorized into low ePVS (< 6.2) and high ePVS (≥ 6.2) using Youden's J statistics. We used the Cox-proportional hazards model, adjusting for age, sex, and body mass index, to investigate the association between high ePVS and major adverse cardiovascular events (MACE) and all-cause mortality within 1 year after ePVS measurement date. Of 305 patients with PH-CKD, 30% (n = 91) had low ePVS, and 70% (n = 215) had high ePVS. Compared to the low ePVS group, patients with high ePVS had higher left ventricular ejection fraction, right atrial pressure, pulmonary artery wedge pressure, and cardiac index, lower pulmonary vascular resistance, worse kidney function, and more chronic anemia. Among patients with precapillary or Cpc-PH, high ePVS was associated with a greater incidence of 1-year all-cause mortality (adjusted HR = 2.11, 95% CI 1.06-4.22 p = 0.034). Among PH-CKD patients, high ePVS was associated with hyperdynamic circulation, worse kidney function, and anemia. High ePVS was associated with greater 1-year all-cause mortality among patients with a precapillary PH component.