Abstract: Objective To observe the incidence, risk factors, and prognostic value of pulmonary arterial
hypertension (PAH) in chronic kidney disease (CKD) patients at stage 1-5 and without dialysis. Methods A
total of 570 CKD patients at stage 1-5 admitted to the Department of Nephrology, Xuanwu Hospital, Capital
Medical University during the period from January1, 2018 to December 31, 2019 were recruited. They were
divided into PAH group and non-PAH group. They were followed up until November 1, 2021, and the end
event was all-cause mortality. Logistic regression was used to analyze the risk factors for PAH in the CKD patients, and Cox proportional hazards regression model was used to analyze the risk factors for death in these
patients. Results The incidence of PAH in the CKD patients was 9.12% (52/570), including 22 patients with
mild PAH (42.31%), 25 patients with moderate PAH (48.08%), and 5 patients with severe PAH (9.61%). Multivariate logistic regression showed that age (OR=1.036, 95% CI:1.008～1.063, P=0.010), complicated with
chronic heart disease (OR=4.373, 95% CI:2.271～8.423, P＜0.001) and hemoglobin lower than 110g/L (OR=
2.218, 95% CI:1.024～4.801, P=0.043) were the risk factors for PAH in CKD patients. The 570 CKD patients
were followed up for an average of 27.3 months, in which 67 cases (11.7%) died and 113 cases (19.8%) lost
the follow-up. Kaplan-Meier survival analysis showed that the survival rate of the CKD patients in PAH group
was significantly lower than those in non-PAH group (log-rank test: χ2=7.089, P=0.009). Multivariate Cox regression model showed that older age (HR=2.502, 95% CI:1.354～4.621, P=0.003) and anemia (HR=2.486,
95% CI:1.397～4.423, P=0.002) were the independent risk factors for all-cause death in CKD patients. Conclusions The incidence of PAH in CKD patients at stage 1-5 was 9.12%. Age, preexisted chronic cardiac disease and lower hemoglobin level were the risk factors for PAH. The survival rate of CKD patients in PAH
group was significantly lower than those in non-PAH group. Older age and anemia were the independent risk
factors for all-cause mortality in CKD patients.

Key words: Pulmonary arterial hypertension, Chronic kidney disease, Risk factor