Renal dysfunction and outcomes in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: an individual participant data meta-analysis.

We sought to characterise renal dysfunction in PAH and CTEPH and to assess the effect of pulmonary hypertension treatment on renal function.

我们试图描述PAH和CTEPH中的肾功能障碍，并评估肺动脉高压治疗对肾功能的影响。

Methods

We performed an individual participant data meta-analysisof 6694 participants from 18 phase III randomised clinical trials of pulmonary hypertension therapies.

我们对来自18项肺动脉高压治疗的III期随机临床试验中的6694名参与者进行了个体患者数据的荟萃分析。

We calculated estimated glomerular filtration rate (eGFR) using the race-agnostic 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

我们使用了2021年种族无关的慢性肾脏病流行病学合作（CKD-EPI）方程来计算估算的肾小球滤过率（eGFR）。

Results

The mean±sd age was 49.6±15.5 years, 78% were female and 58% had idiopathic PAH.

平均年龄为49.6±15.5岁，其中78%为女性，58%患有特发性肺动脉高压。

A total of 907 (13.5%) participants had a baseline eGFR <60 mL·min-1·1.73 m-2.

共有907名（13.5%）参与者基线时的估算肾小球滤过率（eGFR）<60 mL·min-1·1.73 m-2。

Lower baseline eGFR correlated with higher mean right atrial pressure (mRAP) and lower cardiac index.

较低的基础eGFR与较高的平均右房压(mRAP)和较低的心脏指数相关。

At 12-16 weeks, a 10 mmHg decrease in mRAP from baseline or a 1 L·min-1·m-2 increase in cardiac index was associated with only a 1.7 mL·min-1·1.73 m-2 (95% CI -2.9--0.5 mL·min-1·1.73 m-2; p=0.006) or a 1.4 mL·min-1·1.73 m-2 (95% CI 0.5-2.4 mL·min-1·1.73 m-2; p=0.003) increase in eGFR, respectively.

在12-16周时，从基线开始mRAP降低10 mmHg或心脏指数增加1 L·min-1·m-2，分别与eGFR仅增加1.7 mL·min-1·1.73 m-2（95%置信区间-2.9--0.5 mL·min-1·1.73 m-2；p=0.006）或1.4 mL·min-1·1.73 m-2（95%置信区间0.5-2.4 mL·min-1·1.73 m-2；p=0.003）相关。

A 10 mL·min-1·1.73 m-2 lower baseline eGFR was associated with an increased risk of all-cause mortality (adjusted hazard ratio1.16, 95% CI 1.08-1.23; p<0.001).

基线 eGFR 较低 10 mL·min-1·1.73 m-2 与全因死亡风险增加相关（调整后风险比 1.16, 95% 置信区间 1.08-1.23; p<0.001）。

Interestingly, pulmonary hypertension treatment was associated with only a small improvement in eGFR at 12-16 weeks (adjusted β 2.0 mL·min-1·1.73 m-2, 95% CI 1.4-2.6 mL·min-1·1.73 m-2; p<0.001).

有趣的是，肺动脉高压治疗仅在 12-16 周时 eGFR 有小幅改善（调整后 β 2.0 mL·min-1·1.73 m-2, 95% 置信区间 1.4-2.6 mL·min-1·1.73 m-2; p<0.001）。

Conclusions

Renal dysfunction remains highly prevalent in PAH and CTEPH and is associated with worse haemodynamics and worse clinical outcomes.

在肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH）患者中，肾功能障碍的患病率仍然很高，这与较差的血流动力学和较差的临床结果相关。

In this cohort with relatively preserved renal function, pulmonary hypertension treatment was associated with only a minimal improvement in eGFR.

在这组肾功能相对保留的患者中，肺动脉高压治疗仅与eGFR的轻微改善相关。