S THIRUVENGADAM1,2, N KANGAHARAN1,3, M SUNDARAM1
1Royal Darwin Hospital, Darwin, Australia, 2Royal Perth Hospital, Perth, Australia, 3NT Cardiac, Darwin, Australia
Aim: To establish the prevalence of pulmonary hypertension in Indigenous and non-Indigenous haemodialysis patients in the Top End.
Background: Pulmonary hypertension is increasingly reported in patients on longstanding dialysis. Various aetiologies have been hypothesized to predispose pulmonary hypertension in dialysis patients, and it independently predicts cardiovascular events and mortality.
Methods: A database of prevalent haemodialysis patients in the Top End on July 2016 was obtained, which included in-centre, satellite and home-dialysis units. Clinical information was extracted from medical records, dialysis files and the NT Cardiac database of echocardiograms (ECHOs). We classified PASP values as normal, mild, moderate and severe at <30, 30-40, 40-50 and >50 mmHg respectively.
Results: In total, 222 haemodialysis patients in the Top End were identified, of whom 131 patients had an ECHO since 2015 and 67 of them (51.1%) had a PASP recorded. Fifty-four of these patients identified as Indigenous, 11 were Caucasians, and 2 were of other races.Of the 65 patients with pulmonary hypertension, 21 patients (32.3%) had mild, 13 patients (20%) had moderate and 31 patients (47.7%) had severe pulmonary hypertension. There was no correlation with left ventricular hypertrophy (r=0.29) or any clear relationship with volume status, systemic hypertension or co-morbidities.Shortcomings of this study include its retrospective nature and delay between ECHO and volume status assessment.
Conclusion: This is the first descriptive study looking at the rates of pulmonary hypertension in the haemodialysis population in the Top End. The data suggests that pulmonary hypertension is prevalent in at least half of haemodialysis patients and is >40 mmHg (moderate-severe) in 80% of patients. This information will help prospective studies with correlation to volume status and other predisposing pathologies.
Dr. Madhi Sundaram is a Nephrologist working at the Royal Darwin Hospital. Dr Sundaram graduated at Christian Medical College, Vellore in 2007 and worked as a consultant in the same hospital before relocating to Darwin in 2011. Dr Sundaram has more than 25 publications and is now pursuing research in immunologically mediated renal conditions and inherited renal disorders in Indigenous subjects. He is now collaborating with the Victorian clinical Genetic Services and the KIDGEN to establish an active renal genetics clinic in Royal Darwin Hospital.