Легочная гипертензия у больных хронической болезнью почек: распространенность, механизмы развития, перспективы лечения

1. Чазова И.Е., Авдеев С.Н., Царева Н.А. и др. Клинические рекомендации по диагностике и лечению легочной гипертензии. Терапевтический архив. 2014; 9: 4–23. / Chazova I.E., Avdeev S.N., Tsareva N.A. i dr. Klinicheskie rekomendatsii po diagnostike i lecheniiu legochnoi gipertenzii. Therapeutic Archive. 2014; 9: 4–23. [in Russian]
2. Galie N, Hoeper MM, Humbert M et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009; 30: 2493–537.
3. Simonneau G, Gatzoulis MA, Adatia I et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2013; 62: D34–D41.
4. Shang W, Li Y, Ren Y et al. Prevalence of pulmonary hypertension in patients with chronic kidney disease without dialysis: a meta‑analysis. International Urology and Nephrology. Electronic supplementary material.
5. Sise ME, Courtwright A, Channick RN. Pulmonary hypertension in patients with chronic and end-stage kidney disease. Kidney Int 2013; 84: 682–92.
6. Haddad F, Fuh E, Peterson T et al. Incidence, correlates, and consequences of acute kidney injury in patients with pulmonary arterial hypertension hospitalized with acute right-side heart failure. J Card Fail 2011; 17: 533–9.
7. Cheung AK, Sarnak MJ, Yan G et al. Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney Int 2004; 65: 2380–9.
8. Stack AG, Bloembergen WE. A cross-sectional study of the prevalenceand clinical correlates of congestive heart failure among incident US dialysis patients. Am J Kidney Dis 2001; 38: 992–1000.
9. Kraus MA, Hamburger RJ. Sleep apnea in renal failure. Adv Perit Dial 1997; 13: 88–92.
10. Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328: 1230–5.
11. Kumar G, Sakhuja A, Taneja A et al. Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol 2012; 7: 1584–90.
12. Bolignano D, Rastelli S, Agarwal R, et al. Pulmonary Hypertension in CKD. Am J Kidney Dis 2013; 61(4): 612–22.
13. Yigla M, Fruchter O, Aharonson D et al. Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Int 2009; 75: 969–75.
14. Tang M, Batty J, Lin C et al. Pulmonary Hypertension, Mortality, and Cardiovascular Disease in CKD and ESRD Patients: A Systematic Review and Meta-analysis. AJKD 2018; 72: 75–8.
15. Fabbian F, Cantelli S, Molino C et al. Pulmonary hypertension in dialysis patients: a cross-sectional Italian study. Int J Nephrol 2010; 2011: 283475.
16. Ramasubbu K, Deswal A, Herdejurgen C et al. A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance. Int J Gen Med 2010; 3: 279–86.
17. Unal A, Tasdemir K, Oymak S et al. The long-term effects of arteriovenous fistula creation on the development of pulmonary hypertension in hemodialysis patients. Hemodial Int 2010; 14: 398–402.
18. Agarwal R. Prevalence, determinants and prognosis of pulmonary hypertension among hemodialysis patients. Nephrology Dialysis Transplantation 2012; 27: 3908–14.
19. Бородулина E.O., Карпунин С.А., Шутов А.М. Легочная гипертензия у больных на гемодиализе. Клин. нефрология. 2015; 1: 19–22. / Borodulina E.O., Karpunin S.A., Shutov A.M. Legochnaia gipertenziia u bol'nykh na gemodialize. Klin. nefrologiia. 2015; 1: 19–22. [in Russian]
20. Unal A, Sipahioglu M, Oguz F et al. Pulmonary hypertension in peritoneal dialysis patients: prevalence and risk factors. Perit Dial Int 2009; 29: 191–8.
21. Issa N, Krowka MJ, Griffin MD et al. Pulmonary hypertension is associated with reduced patient survival after kidney transplantation. Transplantation 2008; 86: 1384–8.
22. Lam CS, Borlaug BA, Kane GC et al. Age-associated increases in pulmonary artery systolic pressure in the general population. Circulation 2009; 119: 2663–70.
23. Strange G, Playford D, Stewart S et al. Pulmonary hypertension: prevalence and mortality in theArmadale echocardiography cohort. Heart 2012; 98: 1805–11.
24. Руденко Т.Е., Васильева М.П., Соломахина Н.И., Кутырина И.М. Факторы риска развития легочной гипертонии на додиализном этапе хронической болезни почек. Терапевтический архив. 2016; 88 (6): 33–9. / Rudenko T.E., Vasil'eva M.P., Solomakhina N.I., Kutyrina I.M. Faktory riska razvitiia legochnoi gipertonii na dodializnom etape khronicheskoi bolezni pochek. Therapeutic Archive. 2016; 88 (6): 33–9. [in Russian]
25. Pabst S, Hammerstingl C, Hundt F et al. Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-Study. PLoS One 2012; 7: e35310.
26. Abdelwhab S, Elshinnawy S. Pulmonary hypertension in chronic renal failure patients. Am J Nephrol 2008; 28: 990–7.
27. Nakhoul F, Yigla M, Gilman R et al. The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol Dial Transplant 2005; 20: 1686–92.
28. Havlucu Y, Kursat S, Ekmekci C et al. Pulmonary hypertension in patients with chronic renal failure. Respiration 2007; 74: 503–10. DOI: 10.1159/00010295343
29. Yu TM, Chen YH, Hsu JY et аl. Systemic inflammation is associated with pulmonary hypertension in patients undergoing haemodialysis. Nephrol Dial Transplant 2009; 24: 1946–51. DOI: 10.1093/ndt/gfn751
30. Yigla M, Banderski R, Azzam ZS et al. Arterio-venous access in end-stage renal disease patients and pulmonary hypertension. Ther Adv Respir Dis 2008; 2: 49–53.
31. Kawar B, Ellam T, Jackson C, Kiely D. Pulmonary Hypertension in Renal Disease: Epidemiology, Potential Mechanisms and Implications. Am J Nephrol 2013; 37: 281–90.
32. Kosmadakis G, Aguilera D, Carceles O et al. Pulmonary hypertension in dialysispatients. Renal Failure 2013; 35 (4): 514–20.
33. Akmal M, Barndt RR, Ansari AN et al. Excess PTH in CRF induces pulmonary calcification, pulmonary hypertension and right ventricular hypertrophy. Kidney Int 1995; 47: 158–63.
34. Кuzela DC, Huffer WE, Conger JD et al. Soft tissue calcification in chronic dialysis patients. Am J Pathol 1977; 86: 403–24.
35. Yigla M, Keidar Z, Safadi I et al. Pulmonary calcification in hemodialysis patients: correlation with pulmonary artery pressure values. Kidney Int 2004; 66: 806–10.
36. Sun C, Chang HJ, Kim MG et al. Relation ship between pulmonary hypertension, peripheral vascular calcification, and major cardiovascular events indialys is patients. Kidney Res Clin Pract 2015; 34: 28–34.
37. Thambyrajah J, Landray MJ, McGlynn FJ et al. Abnormalities ofendothelial function in patients with predialysis renal failure. Heart 2000; 83: 205–9.
38. Казымлы А.В., Гончарова Н.С., Березина А.В. и др. Исследование сывороточного уровня асимметричного диметиларгинина у больных легочной гипертензией. Артериальная гипертензия. 2014; 1 (20): 45–52. / Kazymly A.V., Goncharova N.S., Berezina A.V. i dr. Issledovanie syvorotochnogo urovnia asimmetrichnogo dimetilarginina u bol'nykh legochnoi gipertenziei. Arterial'naia gipertenziia. 2014; 1 (20): 45–52. [in Russian]
39. Barak M, Nakhoul F, Katz Y. Pathophysiology and clinical implications of microbubbles during hemodialysis. Semin Dial 2008; 21 (3): 232–8.
40. Zhao LJ, Huang SM, Liang T, Tang H. Pulmonary hypertension and right ventricular dysfunction in hemodialysis patients. Eur Rev Med Pharmacological Sci 2014; 18: 3267–73.
41. Kiykim AA, Horoz M, Ozcan T et al. Pulmonary hypertension in haemodialysispatients without arteriovenous fistula: the effect of dialyzer composition. Ren Fail 2010; 23: 1148–52.
42. Zlotnick DM, Axelrod DA, Chobanian MC еt al. Non-invasive detection of pulmonary hypertension prior to renal transplantation is a predictor of increased risk for early graft dysfunction. Nephrol Dial Transpl 2010; 25: 3090–6.
43. Nishimura M, Tokoro T, Yamazaki S, Hashimoto T et al. Idiopathic pre-capillary pulmonary hypertension in patientswith end-stage kidney disease: effect of endothelin receptorantagonists. Clin Exp Nephrol 2017; 21:1088–96.
44. Liefeldt L, van Giersbergen PL, Dingemanse J et al. Treatment ofsecondary pulmonary hypertension with bosentan and itspharmacokinetic monitoring in ESRD. Am J Kidney Dis 2004; 43: 923–6.
45. Califf RM, Adams KF, McKenna WJ et al. A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: The Flolan International Randomized Survival Trial (FIRST). Am Heart J 1997; 134: 44–54.
46. Clarkson MR, Giblin L, Brown A et al. Reversal of pulmonary hypertension after ligation of a brachiocephalic arteriovenous fistula. Am J Kidney Dis 2002; 40: E8.

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1. Chazova I.E., Avdeev S.N., Tsareva N.A. i dr. Klinicheskie rekomendatsii po diagnostike i lecheniiu legochnoi gipertenzii. Therapeutic Archive. 2014; 9: 4–23. [in Russian]
2. Galie N, Hoeper MM, Humbert M et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009; 30: 2493–537.
3. Simonneau G, Gatzoulis MA, Adatia I et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2013; 62: D34–D41.
4. Shang W, Li Y, Ren Y et al. Prevalence of pulmonary hypertension in patients with chronic kidney disease without dialysis: a meta‑analysis. International Urology and Nephrology. Electronic supplementary material.
5. Sise ME, Courtwright A, Channick RN. Pulmonary hypertension in patients with chronic and end-stage kidney disease. Kidney Int 2013; 84: 682–92.
6. Haddad F, Fuh E, Peterson T et al. Incidence, correlates, and consequences of acute kidney injury in patients with pulmonary arterial hypertension hospitalized with acute right-side heart failure. J Card Fail 2011; 17: 533–9.
7. Cheung AK, Sarnak MJ, Yan G et al. Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney Int 2004; 65: 2380–9.
8. Stack AG, Bloembergen WE. A cross-sectional study of the prevalenceand clinical correlates of congestive heart failure among incident US dialysis patients. Am J Kidney Dis 2001; 38: 992–1000.
9. Kraus MA, Hamburger RJ. Sleep apnea in renal failure. Adv Perit Dial 1997; 13: 88–92.
10. Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328: 1230–5.
11. Kumar G, Sakhuja A, Taneja A et al. Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol 2012; 7: 1584–90.
12. Bolignano D, Rastelli S, Agarwal R, et al. Pulmonary Hypertension in CKD. Am J Kidney Dis 2013; 61(4): 612–22.
13. Yigla M, Fruchter O, Aharonson D et al. Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Int 2009; 75: 969–75.
14. Tang M, Batty J, Lin C et al. Pulmonary Hypertension, Mortality, and Cardiovascular Disease in CKD and ESRD Patients: A Systematic Review and Meta-analysis. AJKD 2018; 72: 75–8.
15. Fabbian F, Cantelli S, Molino C et al. Pulmonary hypertension in dialysis patients: a cross-sectional Italian study. Int J Nephrol 2010; 2011: 283475.
16. Ramasubbu K, Deswal A, Herdejurgen C et al. A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance. Int J Gen Med 2010; 3: 279–86.
17. Unal A, Tasdemir K, Oymak S et al. The long-term effects of arteriovenous fistula creation on the development of pulmonary hypertension in hemodialysis patients. Hemodial Int 2010; 14: 398–402.
18. Agarwal R. Prevalence, determinants and prognosis of pulmonary hypertension among hemodialysis patients. Nephrology Dialysis Transplantation 2012; 27: 3908–14.
19. Borodulina E.O., Karpunin S.A., Shutov A.M. Legochnaia gipertenziia u bol'nykh na gemodialize. Klin. nefrologiia. 2015; 1: 19–22. [in Russian]
20. Unal A, Sipahioglu M, Oguz F et al. Pulmonary hypertension in peritoneal dialysis patients: prevalence and risk factors. Perit Dial Int 2009; 29: 191–8.
21. Issa N, Krowka MJ, Griffin MD et al. Pulmonary hypertension is associated with reduced patient survival after kidney transplantation. Transplantation 2008; 86: 1384–8.
22. Lam CS, Borlaug BA, Kane GC et al. Age-associated increases in pulmonary artery systolic pressure in the general population. Circulation 2009; 119: 2663–70.
23. Strange G, Playford D, Stewart S et al. Pulmonary hypertension: prevalence and mortality in theArmadale echocardiography cohort. Heart 2012; 98: 1805–11.
24. Rudenko T.E., Vasil'eva M.P., Solomakhina N.I., Kutyrina I.M. Faktory riska razvitiia legochnoi gipertonii na dodializnom etape khronicheskoi bolezni pochek. Therapeutic Archive. 2016; 88 (6): 33–9. [in Russian]
25. Pabst S, Hammerstingl C, Hundt F et al. Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-Study. PLoS One 2012; 7: e35310.
26. Abdelwhab S, Elshinnawy S. Pulmonary hypertension in chronic renal failure patients. Am J Nephrol 2008; 28: 990–7.
27. Nakhoul F, Yigla M, Gilman R et al. The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol Dial Transplant 2005; 20: 1686–92.
28. Havlucu Y, Kursat S, Ekmekci C et al. Pulmonary hypertension in patients with chronic renal failure. Respiration 2007; 74: 503–10. DOI: 10.1159/00010295343
29. Yu TM, Chen YH, Hsu JY et аl. Systemic inflammation is associated with pulmonary hypertension in patients undergoing haemodialysis. Nephrol Dial Transplant 2009; 24: 1946–51. DOI: 10.1093/ndt/gfn751
30. Yigla M, Banderski R, Azzam ZS et al. Arterio-venous access in end-stage renal disease patients and pulmonary hypertension. Ther Adv Respir Dis 2008; 2: 49–53.
31. Kawar B, Ellam T, Jackson C, Kiely D. Pulmonary Hypertension in Renal Disease: Epidemiology, Potential Mechanisms and Implications. Am J Nephrol 2013; 37: 281–90.
32. Kosmadakis G, Aguilera D, Carceles O et al. Pulmonary hypertension in dialysispatients. Renal Failure 2013; 35 (4): 514–20.
33. Akmal M, Barndt RR, Ansari AN et al. Excess PTH in CRF induces pulmonary calcification, pulmonary hypertension and right ventricular hypertrophy. Kidney Int 1995; 47: 158–63.
34. Кuzela DC, Huffer WE, Conger JD et al. Soft tissue calcification in chronic dialysis patients. Am J Pathol 1977; 86: 403–24.
35. Yigla M, Keidar Z, Safadi I et al. Pulmonary calcification in hemodialysis patients: correlation with pulmonary artery pressure values. Kidney Int 2004; 66: 806–10.
36. Sun C, Chang HJ, Kim MG et al. Relation ship between pulmonary hypertension, peripheral vascular calcification, and major cardiovascular events indialys is patients. Kidney Res Clin Pract 2015; 34: 28–34.
37. Thambyrajah J, Landray MJ, McGlynn FJ et al. Abnormalities ofendothelial function in patients with predialysis renal failure. Heart 2000; 83: 205–9.
38. Kazymly A.V., Goncharova N.S., Berezina A.V. i dr. Issledovanie syvorotochnogo urovnia asimmetrichnogo dimetilarginina u bol'nykh legochnoi gipertenziei. Arterial'naia gipertenziia. 2014; 1 (20): 45–52. [in Russian]
39. Barak M, Nakhoul F, Katz Y. Pathophysiology and clinical implications of microbubbles during hemodialysis. Semin Dial 2008; 21 (3): 232–8.
40. Zhao LJ, Huang SM, Liang T, Tang H. Pulmonary hypertension and right ventricular dysfunction in hemodialysis patients. Eur Rev Med Pharmacological Sci 2014; 18: 3267–73.
41. Kiykim AA, Horoz M, Ozcan T et al. Pulmonary hypertension in haemodialysispatients without arteriovenous fistula: the effect of dialyzer composition. Ren Fail 2010; 23: 1148–52.
42. Zlotnick DM, Axelrod DA, Chobanian MC еt al. Non-invasive detection of pulmonary hypertension prior to renal transplantation is a predictor of increased risk for early graft dysfunction. Nephrol Dial Transpl 2010; 25: 3090–6.
43. Nishimura M, Tokoro T, Yamazaki S, Hashimoto T et al. Idiopathic pre-capillary pulmonary hypertension in patientswith end-stage kidney disease: effect of endothelin receptorantagonists. Clin Exp Nephrol 2017; 21:1088–96.
44. Liefeldt L, van Giersbergen PL, Dingemanse J et al. Treatment ofsecondary pulmonary hypertension with bosentan and itspharmacokinetic monitoring in ESRD. Am J Kidney Dis 2004; 43: 923–6.
45. Califf RM, Adams KF, McKenna WJ et al. A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: The Flolan International Randomized Survival Trial (FIRST). Am Heart J 1997; 134: 44–54.
46. Clarkson MR, Giblin L, Brown A et al. Reversal of pulmonary hypertension after ligation of a brachiocephalic arteriovenous fistula. Am J Kidney Dis 2002; 40: E8.

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2 University Clinical Hospital №3 of I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119435, Russian Federation, Moscow, ul. Rossolimo, d. 11
*atatianaer@yandex.ru