In Reply to ‘Pulmonary Hypertension or Cardiorenal Syndrome: The Devil Is in the Details’

In his letter,1 Dr Kazory raises the concern that selection criteria for pulmonary hypertension may lead to potential confounding by underlying left cardiac dysfunction in our study.2 We acknowledge that patients with pulmonary arterial hypertension are the ideal group. However, given its rarity compared to group 2 pulmonary hypertension, it is difficult to recruit enough patients to study the outcomes in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). In a prospective study conducted by Pabst et al, which assessed patients with CKD and ESRD with right cardiac catheterization, the prevalence of pulmonary artery hypertension was only 6% in patients with CKD stages 4 to 5 and 13% in hemodialysis patients, whereas the prevalence of group 2 pulmonary hypertension was 71% and 65%, respectively.

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