Pulmonary hypertension and correlative factor analysis in refractory secondary hyperparathyroidism of uremia patients

Objective To analyze the incidence of pulmonary hypertension(PH) and the possible factors causing PH in uremia patients with refractory secondary hyperparathyroidism(SHPT).Methods 76 maintenance hemodialysis(MHD) uremia patients with refractory SHPT were assigned as case group and 30 MHD uremia patients without refractory SHPT were assigned as control group.The plasma biochemical features,including serum creatinine,albumin,calcium,phosphorus,alkaline phosphatase,hemoglobin and intact parathyroid hormone were collected before hemodialysis.Systolic pulmonary arterial pressure(SPAP) and parameters relating to cardiac structure and function,including left atrial diameter(LA),main pulmonary artery diameter(PA),right ventricular anteroposterior direction(RVD),left ventricular end-diastolic diameter(LVDd),left ventricular posterior wall thickness(LVPWT),left ventricular myocardial quality index(LVMI),ejection fraction(EF) and the ratio of early diastolic E to late diastolic A were assayed in the following day of hemodialysis.The SHPT patients were further divided into PH group and PH negative group according to SPAP.The plasma biochemical features and clinical data were compared.Results Compared with control group,the incidence and severity of PH were significantly higher in SHPT group(34.2%vs 16.7%,P0.05).SHPT patients with PH had a significantly higher iPTH level and lower calcium level than those SHPT patients without PH(P 0.01 and P 0.05,respectively).The LA,PA,RVD,LVDd,LVPWT,LVMI and incidence of cardiac valvular calcification were significantly higher,but EF and E/A ratio were significantly lower in PH group(P 0.01 and P0.05,respectively).Logistic regression analysis indicated that PTH was the independent risk factor for PH.Conclusion The incidence and severity of PH in refractory SHPT patients are higher than patients without refractory SHPT.The level of iPHT is the independent risk factor for PH in refractory SHPT.