{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:28:49Z","timestamp":1753878529834,"version":"3.41.2"},"reference-count":35,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,9,4]],"date-time":"2022-09-04T00:00:00Z","timestamp":1662249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pulmonary hypertension (PH) is prevalent in those with end\u2010stage kidney disease (ESKD) and poses a barrier to kidney transplant due to its association with poor outcomes. Studies examining these adverse outcomes are limited and often utilize echocardiographic measurements of pulmonary artery systolic pressure (PASP) instead of the gold standard right heart catheterization (RHC). We hypothesized that in ESKD patients deemed ineligible for kidney transplant because of an echocardiographic diagnosis of PH the predominant cause of PH is hypervolemia and is potentially reversible.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a prospective study of 16 patients with ESKD who were denied transplant candidacy. Prior echocardiograms and RHCs were reviewed for confirmation of PH. Patients were admitted for daily sessions of ultrafiltration for volume removal and repeat RHCs were performed following intervention. RHC parameters and body weight were compared before and after intervention. Statistical analysis was performed using PRISM GraphPad software. A<jats:italic>p<\/jats:italic>\u2010value &lt;.05 was considered statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following intervention, the mean pulmonary artery pressure (mPAP) and pulmonary arterial wedge pressure decreased from 45.0 \u00b1 3.06 to 29.1 \u00b1 7.77 mmHg (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0001) and 22.2\u00a0\u00b1\u00a05.06 to 13.1\u00a0\u00b1\u00a07.25\u00a0mmHg (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.003), respectively. The pulmonary vascular resistance decreased from 4.73\u00a0\u00b1\u00a01.99 to 4.28\u00a0\u00b1\u00a02.07\u00a0WU (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.30). Eleven patients from the initial cohort underwent successful kidney transplantation\u00a0post\u2010intervention with 100% survival at 1\u2010year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In ESKD patients, diagnoses of PH made by echocardiography may be largely due to hypervolemia and may be optimized using an intensive ultrafiltration strategy to restore transplant candidacy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14799","type":"journal-article","created":{"date-parts":[[2022,8,27]],"date-time":"2022-08-27T10:07:42Z","timestamp":1661594862000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intensive ultrafiltration strategy restores kidney transplant candidacy for patients with echocardiographic evidence of pulmonary hypertension"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9885-6218","authenticated-orcid":false,"given":"Kranthikiran","family":"Earasi","sequence":"first","affiliation":[{"name":"Department of Medicine University of Virginia Charlottesville Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3147-1687","authenticated-orcid":false,"given":"John","family":"Mihaltses","sequence":"additional","affiliation":[{"name":"Eastern Nephrology Associates Wilmington North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie L. W.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Inova Heart and Vascular Institute Falls Church Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swati","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Virginia Charlottesville Virginia USA"},{"name":"Division of Nephrology University of Virginia Charlottesville Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Holsten","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Virginia Charlottesville Virginia USA"},{"name":"Division of Nephrology University of Virginia Charlottesville Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sula","family":"Mazimba","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Virginia Charlottesville Virginia USA"},{"name":"Division of Cardiovascular Medicine University of Virginia Charlottesville Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alden","family":"Doyle","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Virginia Charlottesville Virginia USA"},{"name":"Division of Nephrology University of Virginia Charlottesville Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew D.","family":"Mihalek","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Virginia Charlottesville Virginia USA"},{"name":"Division of Pulmonary and Critical Care Medicine University of Virginia Charlottesville Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,9,4]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-020-00355-0"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.10.007"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000348804"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfq141"},{"key":"e_1_2_10_6_1","unstructured":"BozbasS AkcayS AltinC et\u00a0al.Pulmonary hypertension in patients with end\u2010stage renal disease undergoing renal transplantation.Paper presented at: Transplantation proceedings2009."},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.5.1577"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","unstructured":"YiglaM AbassiZ ReisnerSA NakhoulF.Pulmonary hypertension in hemodialysis patients: an unrecognized threat.Paper presented at: Seminars in 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