■要估计预测因子,慢性肾脏病(CKD)患者肺动脉高压(PH)的患病率和预后作用的Meta分析.
■PubMed,Embase,从开始到2024年5月,系统搜索了Cochrane图书馆的合格研究。所有的汇总分析均使用随机效应模型进行。
■选择了涉及17,558名CKD患者的50项观察性研究。CKD患者中PH的患病率为38%(95%置信区间[CI]:33%-43%),根据CKD状态,CKD(I-V)的患病率为31%(95%CI:20%-42%),39%(95%CI:25%-54%)用于终末期肾脏疾病(ESKD)(透析前),42%(95%CI:35%-50%)用于ESKD(血液透析),26%(95%CI:19%-34%)用于肾移植。我们注意到CKD中PH的危险因素包括Black个体(相对风险[RR]:1.39;95%CI:1.18-1.63;p<0.001),慢性阻塞性肺疾病(RR:1.48;95%CI:1.21-1.82;p<0.001),心血管疾病史(RR:1.62;95%CI:1.05-2.51;p=0.030),更长的透析时间(RR:1.70;95%CI:1.18-2.46;p=0.005),舒张功能障碍(RR:1.88;95%CI:1.38-2.55;p<0.001),收缩功能障碍(RR:3.75;95%CI:2.88-4.87;p<0.001),和5级CKD(RR:5.64;95%CI:3.18-9.98;p<0.001)。此外,CKD患者的PH也与不良预后有关,包括全因死亡率,主要心血管事件,和心脏死亡。
■这项研究系统地确定了CKD患者PH的危险因素,PH与不良预后相关。因此,应明确PH患病率高的患者进行治疗.
UNASSIGNED: To estimate the predictors, prevalence and prognostic role of pulmonary hypertension (PH) in patients with chronic kidney disease (CKD) using meta-analysis.
UNASSIGNED: The PubMed, EmBase, and the Cochrane library were systematically searched for eligible studies from inception till May 2024. All of pooled analyses were performed using the random-effects model.
UNASSIGNED: Fifty observational studies involving 17,558 CKD patients were selected. The prevalence of PH in CKD patients was 38% (95% confidence interval [CI]: 33%-43%), and the prevalence according to CKD status were 31% (95% CI: 20%-42%) for CKD (I-V), 39% (95% CI: 25%-54%) for end stage kidney disease (ESKD) (predialysis), 42% (95% CI: 35%-50%) for ESKD (hemodialysis), and 26% (95% CI: 19%-34%) for renal transplant. We noted the risk factors for PH in CKD included Black individuals (relative risk [RR]: 1.39; 95% CI: 1.18-1.63; p < 0.001), chronic obstructive pulmonary disease (RR: 1.48; 95% CI: 1.21-1.82; p < 0.001), cardiovascular disease history (RR: 1.62; 95% CI: 1.05-2.51; p = 0.030), longer dialysis (RR: 1.70; 95% CI: 1.18-2.46; p = 0.005), diastolic dysfunction (RR: 1.88; 95% CI: 1.38-2.55; p < 0.001), systolic dysfunction (RR: 3.75; 95% CI: 2.88-4.87; p < 0.001), and grade 5 CKD (RR: 5.64; 95% CI: 3.18-9.98; p < 0.001). Moreover, PH in CKD patients is also associated with poor prognosis, including all-cause mortality, major cardiovascular events, and cardiac death.
UNASSIGNED: This study systematically identified risk factors for PH in CKD patients, and PH were associated with poor prognosis. Therefore, patients with high prevalence of PH should be identified for treatment.