Abstract: Objective To explore the influencing factors of pulmonary arterial hypertension (PAH) in maintenance hemodialysis patients (MHD) and provide scientific recommendations for clinical diagnosis and treatment. Methods  End-stage renal disease (ESRD) patients receiving MHD treatment at the First Affiliated Hospital of Henan University of Science and Technology from January 2022 to April 2025 were selected. Patients were divided into a PAH group (defined as pulmonary artery systolic pressure > 35 mmHg) and a non-PAH group based on PAH occurrence. Demographic data, laboratory test indicators, and echocardiographic findings of the two groups were collected, organized, and compared to analyze their correlation with PAH occurrence.  Result A total of 159 subjects were included, of which 66 (41.51%) developed PAH. Statistically significant differences were observed between the PAH and non-PAH groups in serum calcium (t=2.173, P=0.031), albumin (t=3.526, P=0.001), hemoglobin (t=4.357, P＜0.001), platelet count (Z=-2.866, P=0.004), D-dimer (Z=-2.188, P=0.029), dialysis vintage ≥3 years (χ²=4.781, P=0.029), percutaneous transluminal angioplasty (PTA) and catheter-directed thrombolysis ≥2 times (χ²=5.710, P=0.017), history of cuffed catheter placement (χ²=5.695, P=0.017), left atrial anterior-posterior diameter (t=-2.255, P=0.026), left ventricular anterior-posterior diameter (Z=-2.022, P=0.043), right atrial transverse diameter (t=-2.335,P=0.022), right ventricular anterior-posterior diameter (Z=-2.496, P=0.013), pulmonary artery diameter (Z=-2.270, P=0.023), and left ventricular ejection fraction (Z=-2.224, P=0.026). Multivariate binary logistic regression analysis revealed that decreased albumin (OR=0.893, 95% CI: 0.817～0.976, P=0.013), decreased hemoglobin (OR=0.954, 95% CI: 0.931～0.978, P＜0.001), elevated D-dimer (OR=1.156, 95% CI: 1.057～1.263, P=0.001), dialysis vintage≥3 years (OR=2.861, 95% CI: 1.174～6.975, P=0.021), PTA and catheter-directed thrombolysis≥2 times (OR=2.572, 95% CI: 1.120～5.907, P=0.026), and history of cuffed catheter placement (OR=4.057, 95% CI: 1.290～12.755, P=0.017) were independent risk factors for PAH.  Conclusion  The incidence of PAH in MHD patients was 41.51%. Decreased hemoglobin and albumin, elevated D-dimer, dialysis vintage≥3 years, PTA and catheter-directed thrombolysis≥2 times, and history of cuffed catheter placement are independent risk factors for PAH in MHD patients, suggesting that targeted treatment may reduce the incidence of PAH and improve patients' quality of life

Key words: Maintenance hemodialysis, Pulmonary hypertension, Risk factors