{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T05:22:50Z","timestamp":1788672170351,"version":"build-2803163510"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","funder":[{"DOI":"10.13039\/100014240","name":"American Kidney Fund","doi-asserted-by":"crossref","award":["Clinical Scientist in Nephrology Fellowship"],"award-info":[{"award-number":["Clinical Scientist in Nephrology Fellowship"]}],"id":[{"id":"10.13039\/100014240","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,4]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Lower eGFR and higher B-type natriuretic peptide are associated with increased odds of developing pulmonary hypertension.<\/jats:p>\n <\/jats:list-item>\n \n Albuminuria was not associated with the development of incident pulmonary hypertension.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Pulmonary hypertension (PH) is a common comorbid condition in patients with CKD and is associated with high mortality. We sought to identify the incidence of PH and the relation of kidney function and volume status to its development in a large cohort of patients with CKD.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The study sample included 1076 participants from the Chronic Renal Insufficiency Cohort Study with two or more measurements of tricuspid regurgitation velocity by transthoracic echocardiography. Incident PH was defined as a tricuspid regurgitation velocity of \u22652.8 m\/s (reflecting a right ventricular systolic pressure gradient \u226531 mm Hg). Multivariable logistic regression adjusting for demographics, comorbid conditions, and medications was used to evaluate the relation of kidney function (eGFR and albuminuria) as well as B-type natriuretic peptide (BNP) to incident PH.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Over a median of 3.0 years, 120 patients developed incident PH (incidence rate 2.70 cases per 100 person-years). Each 10 ml\/min per 1.73 m\n 2<\/jats:sup>\n lower eGFR was associated with 29% (odds ratio, 1.29; 95% confidence interval, 1.10 to 1.52) higher odds of the development of PH after adjustment for confounders, while each doubling of BNP was associated with a 32% (odds ratio, 1.32; 95% confidence interval, 1.15 to 1.51) higher odds. There was no significant relation between urine albumin excretion and incident PH.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n eGFR and BNP were independently associated with the development of incident PH. Closer attention to these potentially modifiable risk factors is warranted to slow the progression of this common comorbidity of patients with CKD.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000000938","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T10:00:40Z","timestamp":1766138440000},"page":"544-552","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Incident Pulmonary Hypertension and Its Risk Factors in CKD"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1246-8879","authenticated-orcid":false,"given":"Marcelle","family":"Tuttle","sequence":"first","affiliation":[{"name":"Tufts Medical Center, Boston, Massachusetts"},{"name":"Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1448-327X","authenticated-orcid":false,"given":"Hocine","family":"Tighiouart","sequence":"additional","affiliation":[{"name":"Tufts Medical Center, Boston, Massachusetts"},{"name":"Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9507-3506","authenticated-orcid":false,"given":"Tatsufumi","family":"Oka","sequence":"additional","affiliation":[{"name":"Osaka University Graduate School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"McCallum","sequence":"additional","affiliation":[{"name":"Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8242-8339","authenticated-orcid":false,"given":"Nicholas S.","family":"Hill","sequence":"additional","affiliation":[{"name":"Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sankar","family":"Navaneethan","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Kawut","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1860-6302","authenticated-orcid":false,"given":"Mark J.","family":"Sarnak","sequence":"additional","affiliation":[{"name":"Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"issue":"3","key":"B1-20260417","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1681\/ASN.2014111111","article-title":"Prevalence, predictors, and outcomes of pulmonary hypertension in CKD","volume":"27","author":"Navaneethan","year":"2016","journal-title":"J Am Soc Nephrol."},{"issue":"1","key":"B2-20260417","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1053\/j.ajkd.2017.11.018","article-title":"Pulmonary hypertension, mortality, and cardiovascular disease in CKD and ESRD patients: a systematic review and meta-analysis","volume":"72","author":"Tang","year":"2018","journal-title":"Am J Kidney Dis."},{"issue":"1","key":"B3-20260417","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1038\/ki.2015.27","article-title":"High estimated pulmonary artery systolic pressure predicts adverse cardiovascular outcomes in stage 2-4 chronic kidney disease","volume":"88","author":"Bolignano","year":"2015","journal-title":"Kidney Int."},{"issue":"6","key":"B4-20260417","doi-asserted-by":"crossref","first-page":"e003940","DOI":"10.1161\/CIRCHEARTFAILURE.116.003940","article-title":"Pulmonary hypertension is associated with a higher risk of heart failure hospitalization and mortality in patients with chronic kidney disease: the Jackson heart study","volume":"10","author":"Selvaraj","year":"2017","journal-title":"Circ Heart Fail."},{"issue":"6","key":"B5-20260417","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1053\/j.ajkd.2019.12.005","article-title":"Diagnosis and management of pulmonary hypertension in patients with CKD","volume":"75","author":"Walther","year":"2020","journal-title":"Am J Kidney Dis."},{"issue":"8","key":"B6-20260417","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1161\/CIRCRESAHA.123.321752","article-title":"Endothelial cell dysfunction and increased cardiovascular risk in patients with chronic kidney disease","volume":"132","author":"Baaten","year":"2023","journal-title":"Circ Res."},{"issue":"5","key":"B7-20260417","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1053\/j.ajkd.2019.08.027","article-title":"Pulmonary hypertension subtypes and mortality in CKD","volume":"75","author":"Edmonston","year":"2020","journal-title":"Am J Kidney Dis."},{"issue":"8","key":"B8-20260417","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1093\/ndt\/gfh840","article-title":"The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access","volume":"20","author":"Nakhoul","year":"2005","journal-title":"Nephrol Dial Transplant."},{"issue":"8","key":"B9-20260417","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.2215\/CJN.00070109","article-title":"Chronic Renal Insufficiency Cohort (CRIC) study: baseline characteristics and associations with kidney function","volume":"4","author":"Lash","year":"2009","journal-title":"Clin J Am Soc Nephrol."},{"issue":"7 suppl 2","key":"B10-20260417","doi-asserted-by":"crossref","first-page":"S148","DOI":"10.1097\/01.ASN.0000070149.78399.CE","article-title":"The Chronic Renal Insufficiency Cohort (CRIC) study: design and methods","volume":"14","author":"Feldman","year":"2003","journal-title":"J Am Soc Nephrol."},{"issue":"19","key":"B11-20260417","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New Creatinine- and cystatin C\u2013Based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med."},{"issue":"38","key":"B12-20260417","doi-asserted-by":"crossref","first-page":"3618","DOI":"10.1093\/eurheartj\/ehac237","article-title":"2022 ESC\/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: developed by 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 for Heart and Lung Transplantation (ISHLT) and the European Reference Network on rare respiratory diseases (ERN-LUNG)","volume":"43","author":"Humbert","year":"2022","journal-title":"Eur Heart J."},{"issue":"10","key":"B13-20260417","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1253\/circrep.CR-20-0094","article-title":"Optimal cut-off of tricuspid regurgitation velocity according to the new definition of pulmonary hypertension \u2015 its use in predicting pulmonary hypertension","volume":"2","author":"Sumimoto","year":"2020","journal-title":"Circ Rep."},{"issue":"12","key":"B14-20260417","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1016\/j.ekir.2020.09.033","article-title":"Echocardiography to screen for pulmonary hypertension in CKD","volume":"5","author":"Edmonston","year":"2020","journal-title":"Kidney Int Rep."},{"issue":"3","key":"B15-20260417","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1177\/2045893217716108","article-title":"Pulmonary hypertension in patients with chronic kidney disease: invasive hemodynamic etiology and outcomes","volume":"7","author":"O\u2019Leary","year":"2017","journal-title":"Pulm Circ."},{"issue":"5","key":"B16-20260417","doi-asserted-by":"crossref","first-page":"925","DOI":"10.4103\/1319-2442.118080","article-title":"Progressive pulmonary hypertension: another criterion for expeditious renal transplantation","volume":"24","author":"Reddy","year":"2013","journal-title":"Saudi J Kidney Dis Transpl."},{"issue":"9","key":"B17-20260417","doi-asserted-by":"crossref","first-page":"3524","DOI":"10.1016\/j.transproceed.2010.06.026","article-title":"The effect of successful kidney transplantation on ventricular dysfunction and pulmonary hypertension","volume":"42","author":"Casas-Aparicio","year":"2010","journal-title":"Transplant Proc."},{"issue":"5","key":"B18-20260417","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1038\/ki.2014.143","article-title":"Endothelin and endothelin antagonists in chronic kidney disease","volume":"86","author":"Kohan","year":"2014","journal-title":"Kidney Int."},{"issue":"3","key":"B19-20260417","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1046\/j.1523-1755.2000.00281.x","article-title":"Total nitric oxide production is low in patients with chronic renal disease","volume":"58","author":"Schmidt","year":"2000","journal-title":"Kidney Int."},{"key":"B20-20260417","doi-asserted-by":"crossref","first-page":"123","DOI":"10.3389\/fcell.2020.00123","article-title":"Diverse role of TGF-\u03b2 in kidney disease","volume":"8","author":"Gu","year":"2020","journal-title":"Front Cell Dev Biol."},{"issue":"2","key":"B21-20260417","doi-asserted-by":"crossref","first-page":"2002341","DOI":"10.1183\/13993003.02341-2020","article-title":"Targeting transforming growth factor-\u03b2 receptors in pulmonary hypertension","volume":"57","author":"Guignabert","year":"2021","journal-title":"Eur Respir J."},{"issue":"16","key":"B22-20260417","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1056\/NEJMoa2213558","article-title":"Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension","volume":"388","author":"Hoeper","year":"2023","journal-title":"N Engl J Med."},{"issue":"92","key":"B23-20260417","doi-asserted-by":"crossref","first-page":"S42","DOI":"10.1111\/j.1523-1755.2004.09211.x","article-title":"Microalbuminuria is associated with impaired brachial artery, flow-mediated vasodilation in elderly individuals without and with diabetes: further evidence for a link between microalbuminuria and endothelial dysfunction\u2014The Hoorn study","volume":"66","author":"Stehouwer","year":"2004","journal-title":"Kidney Int."},{"issue":"1","key":"B24-20260417","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s12882-018-0866-9","article-title":"Epidemiology and risk factors in CKD patients with pulmonary hypertension: a retrospective study","volume":"19","author":"Zhang","year":"2018","journal-title":"BMC Nephrol."},{"issue":"12","key":"B25-20260417","doi-asserted-by":"crossref","first-page":"3033","DOI":"10.3390\/diagnostics12123033","article-title":"Biomarkers in pulmonary arterial hypertension","volume":"12","author":"Hojda","year":"2022","journal-title":"Diagnostics."},{"issue":"8","key":"B26-20260417","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1093\/ndt\/gfw345","article-title":"Haemodialysis acutely deteriorates left and right diastolic function and myocardial performance: an effect related to high ultrafiltration volumes?","volume":"32","author":"Sarafidis","year":"2017","journal-title":"Nephrol Dial Transplant."},{"issue":"4","key":"B27-20260417","doi-asserted-by":"crossref","first-page":"e35310","DOI":"10.1371\/journal.pone.0035310","article-title":"Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-study","volume":"7","author":"Pabst","year":"2012","journal-title":"PLoS One."},{"issue":"13","key":"B28-20260417","doi-asserted-by":"crossref","first-page":"e009362","DOI":"10.1161\/JAHA.118.009362","article-title":"Lack of a tricuspid regurgitation doppler signal and pulmonary hypertension by invasive measurement","volume":"7","author":"O\u2019Leary","year":"2018","journal-title":"J Am Heart Assoc."}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000938","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:36:01Z","timestamp":1786368961000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000938"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.0000000938","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,1]]},"assertion":[{"value":"2025-05-28","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-25","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}