Original Article

Impact of Pulmonary Hypertension on Renal Functions in Obstructive Sleep Apnea Syndrome

Authors: Meral Uyar, Professor

Abstract

Objectives: Pulmonary hypertension (PH) is common in obstructive sleep apnea syndrome (OSAS). This study aimed to evaluate the effect of PH on kidney functions in patients with OSAS.

Methods: The data of patients who were diagnosed as having OSAS after referral to the sleep center in the Gaziantep University Medical Faculty between January 2005 and June 2017 were evaluated. The estimated glomerular filtration rate was calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Renal functions of the subjects who had data after 5 years were included for long-term analysis.

Results: A total of 2152 patients with OSAS (n = 1540), PH (n = 49), OSAS and PH coexistence (n = 359), and the control group (n = 204) were included in the study. Pulmonary arterial pressure (PAP) was 44.51 ± 23.73 in the PH group; it was 37.1 ± 13.14 in the group with OSAS + PH (P = 0.001) Urea and uric acid were found to be higher in the association of OSAS + PH. CKD-EPI was lower in the presence of PH or OSAS + PH than in the presence of OSAS. PH was present in 16.06% of males and 25.10% of females (P = 0.000), and PAP was detected as 35.80 ± 13.23 and 40.96 ± 16.65, respectively (P = 0.001). PH was present in 15.99% of males and 25.84% of females with OSAS (P = 0.000). The PAP of males with OSAS was 36.03 ± 13.46, and the PAP of females was 38.68 ± 12.55 (P = 0062). Urea, creatinine, and uric acid were higher and CKD-EPI was lower in male subjects in the presence of OSAS and PH, whereas the same scenario also was present in the presence of PH alone in female subjects. Long-term comparisons (n = 343) revealed significant decreases in the CKD-EPI in those with OSAS and OSAS + PH and these decrease were more pronounced in the presence of OSAS and PH. The regression analysis revealed that female patients had lower CKD-EPI in the presence of PH, although the presence of PH had no effect on CKD-EPI in males.

Conclusions: PH is a risk factor for the deterioration of renal function in OSAS and more prominent in the long term.
Posted in: Nephrology and Urology25

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Uyar M, Davutoglu V. An update on cardiovascular effects of obstructive sleep apnoea syndrome. Postgrad Med J 2016;92:540–544.
 
2. Baysal E, Taysi S, Aksoy N, et al. Serum paraoxonase, arylesterase activity and oxidative status in patients with obstructive sleep apnea syndrome (OSAS). Eur Rev Med Pharmacol Sci 2012;16:770–774.
 
3. Kholdani C, Fares WH, Mohsenin V. Pulmonary hypertension in obstructive sleep apnea: is it clinically significant? A critical analysis of the association and pathophysiology. Pulm Circ 2015;5:220–227.
 
4. Sascău R, Zota IM, Stătescu C, et al. Review of echocardiographic findings in patients with obstructive sleep apnea. Can Respir J 2018;1206217.
 
5. Rosenkranz S, Howard LS, Gomberg-Maitland M, et al. Systemic consequences of pulmonary hypertension and right-sided heart failure. Circulation 2020; 141:678–693.
 
6. Uk Kang T, Park KY, Kim HJ, et al. Association of hyperuricemia and pulmonary hypertension: a systematic review and meta-analysis. Mod Rheumatol 2019;29:1031–1041.
 
7. Schoenberg NC, Argula RG, Klings ES, et al. Prevalence and mortality of pulmonary hypertension in ESRD: a systematic review and meta-analysis. Lung 2020;198:535–545.
 
8. Reque J, Garcia-Prieto A, Linares T, et al. Pulmonary hypertension is associated with mortality and cardiovascular events in chronic kidney disease patients. Am J Nephrol 2017;45:107–114.
 
9. Zhang Q,Wang L, Zeng H, et al. Epidemiology and risk factors in CKD patients with pulmonary hypertension: a retrospective study. BMC Nephrol 2018;19:70.
 
10. American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005.
 
11. Task Force for Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC); European Respiratory Society (ERS); International Society of Heart and Lung Transplantation (ISHLT), et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 2009;34:1219–1263.
 
12. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). Ann Intern Med 2009;150:604–612.
 
13. Liu T, Zhan Y, Wang Y, et al. Obstructive sleep apnea syndrome and risk of renal impairment: a systematic review and meta-analysis with trial sequential analysis. Sleep Breath 2021;25:17–27.
 
14. Hwu DW, Lin KD, Lin KC, et al. The association of obstructive sleep apnea and renal outcomes-a systematic review and meta-analysis. BMC Nephrol 2017;18:313.
 
15. Uyar M, Davutoğlu V, Gündoğdu N, et al. Renal functions in obstructive sleep apnea patients. Sleep Breath 2016;20:191–195.
 
16. Chakinala MM, Coyne DW, Benza RL, et al. Impact of declining renal function on outcomes in pulmonary arterial hypertension: a REVEAL Registry analysis. J Heart Lung Transplant 2018;37:696–705.
 
17. Spiesshoefer J, Herkenrath S, Harre K, et al. Sleep-disordered breathing and nocturnal hypoxemia in precapillary pulmonary hypertension: prevalence, pathophysiological determinants, and clinical consequences. Respiration 2021;100:865–876.
 
18. Marrone O, Battaglia S, Steiropoulos P, et al. Chronic kidney disease in European patients with obstructive sleep apnea: the ESADA cohort study. J Sleep Res 2016;25:739–745.
 
19. Xie J, Fan Z, Yisilamu P, et al. Hypoxemia and pulmonary hypertension in patients with concomitant restrictive ventilatory defect and sleep apnea: the overlap syndrome. Sleep Breath 2021;25:1173–1179.
 
20. Somkearti P, Chattakul P, Khamsai S, et al. Predictors of chronic kidney disease in obstructive sleep apnea patients. Multidiscip Respir Med 2020;15:470.