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Kidney dysfunction in patients with pulmonary arterial hypertension

Pulmonary arterial hypertension (PH) and chronic kidney disease (CKD) both profoundly impact patient outcomes, whether as primary disease states or as co-morbid conditions. PH is a common co-morbidity in CKD and vice versa. A growing body of literature describes the epidemiology of PH secondary to c...

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Autores principales: Nickel, N.P., O’Leary, J.M., Brittain, E.L., Fessel, J.P., Zamanian, R.T., West, J.D., Austin, E.D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5448543/
https://www.ncbi.nlm.nih.gov/pubmed/28680564
http://dx.doi.org/10.1086/690018
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author Nickel, N.P.
O’Leary, J.M.
Brittain, E.L.
Fessel, J.P.
Zamanian, R.T.
West, J.D.
Austin, E.D.
author_facet Nickel, N.P.
O’Leary, J.M.
Brittain, E.L.
Fessel, J.P.
Zamanian, R.T.
West, J.D.
Austin, E.D.
author_sort Nickel, N.P.
collection PubMed
description Pulmonary arterial hypertension (PH) and chronic kidney disease (CKD) both profoundly impact patient outcomes, whether as primary disease states or as co-morbid conditions. PH is a common co-morbidity in CKD and vice versa. A growing body of literature describes the epidemiology of PH secondary to chronic kidney disease and end-stage renal disease (ESRD) (WHO group 5 PH). But, there are only limited data on the epidemiology of kidney disease in group 1 PH (pulmonary arterial hypertension [PAH]). The purpose of this review is to summarize the current data on epidemiology and discuss potential disease mechanisms and management implications of kidney dysfunction in PAH. Kidney dysfunction, determined by serum creatinine or estimated glomerular filtration rate, is a frequent co-morbidity in PAH and impaired kidney function is a strong and independent predictor of mortality. Potential mechanisms of PAH affecting the kidneys are increased venous congestion, decreased cardiac output, and neurohormonal activation. On a molecular level, increased TGF-β signaling and increased levels of circulating cytokines could have the potential to worsen kidney function. Nephrotoxicity does not seem to be a common side effect of PAH-targeted therapy. Treatment implications for kidney disease in PAH include glycemic control, lifestyle modification, and potentially Renin-Angiotensin-Aldosterone System (RAAS) blockade.
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spelling pubmed-54485432017-06-08 Kidney dysfunction in patients with pulmonary arterial hypertension Nickel, N.P. O’Leary, J.M. Brittain, E.L. Fessel, J.P. Zamanian, R.T. West, J.D. Austin, E.D. Pulm Circ Review Articles Pulmonary arterial hypertension (PH) and chronic kidney disease (CKD) both profoundly impact patient outcomes, whether as primary disease states or as co-morbid conditions. PH is a common co-morbidity in CKD and vice versa. A growing body of literature describes the epidemiology of PH secondary to chronic kidney disease and end-stage renal disease (ESRD) (WHO group 5 PH). But, there are only limited data on the epidemiology of kidney disease in group 1 PH (pulmonary arterial hypertension [PAH]). The purpose of this review is to summarize the current data on epidemiology and discuss potential disease mechanisms and management implications of kidney dysfunction in PAH. Kidney dysfunction, determined by serum creatinine or estimated glomerular filtration rate, is a frequent co-morbidity in PAH and impaired kidney function is a strong and independent predictor of mortality. Potential mechanisms of PAH affecting the kidneys are increased venous congestion, decreased cardiac output, and neurohormonal activation. On a molecular level, increased TGF-β signaling and increased levels of circulating cytokines could have the potential to worsen kidney function. Nephrotoxicity does not seem to be a common side effect of PAH-targeted therapy. Treatment implications for kidney disease in PAH include glycemic control, lifestyle modification, and potentially Renin-Angiotensin-Aldosterone System (RAAS) blockade. SAGE Publications 2017-03-13 /pmc/articles/PMC5448543/ /pubmed/28680564 http://dx.doi.org/10.1086/690018 Text en © 2017 by Pulmonary Vascular Research Institute http://creativecommons.org/licenses/by-nc/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review Articles
Nickel, N.P.
O’Leary, J.M.
Brittain, E.L.
Fessel, J.P.
Zamanian, R.T.
West, J.D.
Austin, E.D.
Kidney dysfunction in patients with pulmonary arterial hypertension
title Kidney dysfunction in patients with pulmonary arterial hypertension
title_full Kidney dysfunction in patients with pulmonary arterial hypertension
title_fullStr Kidney dysfunction in patients with pulmonary arterial hypertension
title_full_unstemmed Kidney dysfunction in patients with pulmonary arterial hypertension
title_short Kidney dysfunction in patients with pulmonary arterial hypertension
title_sort kidney dysfunction in patients with pulmonary arterial hypertension
topic Review Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5448543/
https://www.ncbi.nlm.nih.gov/pubmed/28680564
http://dx.doi.org/10.1086/690018
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