SUMMARY
Aim of the study. To evaluate the relationship between pulmonary artery pressure and hydration status in patients undergoing hemodialysis, and to assess the effect of achieving optimal dry weight on the dynamics of pulmonary hypertension. Material and methods. A total of 52 patients (20 males and 32 females; mean age 55±12 years) with stage 5 chronic kidney disease (CKD) on maintenance hemodialysis (HD) were prospectively enrolled. Hydration status and dry weight were assessed by multifrequency bioimpedance analysis (ABC-01 device, MEDAS, Sport-5 software). Pulmonary artery pressure was evaluated by Doppler echocardiography at baseline and after 12 months of HD therapy in accordance with European Society of Cardiology criteria. Echocardiographic parameters included left ventricular mass index (LVMI), ejection fraction (EF), and systolic pulmonary artery pressure (sPAP). Statistical analyses employed Student’s t-test and univariate correlation analysis; p<0.05 was considered statistically significant. Results. Pulmonary hypertension (PH) was detected in 58% of patients. After one year of HD, sPAP decreased from 46.3±16.1 to 40.4±11.7 mmHg (p<0.01), LVMI declined from 159.1±35.8 to 129.1±42.2 g/m² (p<0.05), and hemoglobin improved from 106.5±18.7 to 113.9±11.5 g/L (p<0.01). Mean total body water (TBW) was 34.1±6.5 L; extracellular water (ECW) was 21.5±4.4 L. A significant positive correlation was found between ECW and sPAP (r=0.4; p<0.01). No statistically significant relationship was found between arteriovenous (AV) fistula blood flow and pulmonary artery pressure. Conclusion. PH in HD patients at initiation of therapy is closely associated with left ventricular hypertrophy, impaired systolic function, and anemia. After one year of maintenance HD, significant regression of PH and left ventricular hypertrophy (LVH) was observed, attributable to improved volume control and anemia correction. AV fistula function does not independently contribute to PH severity. Bioimpedance-guided hydration monitoring is an important tool for cardiovascular risk reduction in this population.
Keywords: hemodialysis, pulmonary hypertension, bioimpedance analysis, extracellular water, left ventricular hypertrophy, volume overload

---

REFERENCES

1. Stoumpos S, Rankin A, Hall Barrientos P, Mangion K, et al. Interrogating the haemodynamic effects of haemodialysis arteriovenous fistula on cardiac structure and function // Scientific Reports. 2021;11:18102. doi: 10.1038/s41598-021-97625-5
2. Patel S, Ashokkumar S, Green A. Modern tools for optimizing fluid management in dialysis patients: a comprehensive review // BMC Nephrology. 2024;25:464. doi: 10.1186/s12882-024-03856-9
3. Pabst S, Hammerstingl C, Hundt F, Gerhardt T, et al. Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-study // PLoS One. 2012;7(4):e35310. doi: 10.1371/journal.pone.0035310
4. Unal A, Duran M, Tasdemir K, Oymak S, et al. Does arterio-venous fistula creation affects development of pulmonary hypertension in hemodialysis patients? // Renal Failure. 2013;35(3):344–351. doi: 10.3109/0886022X.2012.760407
5. Onofriescu M, Hogas S, Voroneanu L, Apetrii M, et al. Bioimpedance-guided fluid management in maintenance hemodialysis: a pilot randomized controlled trial // American Journal of Kidney Diseases. 2014;64(1):111–118. doi: 10.1053/j.ajkd.2014.01.420
6. Cheng L, Chang L, Tian R, Zhou J, et al. The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis // Renal Failure. 2022;44(1):1192–1200. doi: 10.1080/0886022X.2022.2095287
7. Hur E, Usta M, Toz H, Asci G, et al. Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients: a randomized controlled trial // American Journal of Kidney Diseases. 2013;61(6):957–965. doi: 10.1053/j.ajkd.2012.12.017
8. Chen H-S, Chang Y-C, Hsieh M-H, Tseng F-L, et al. Application of bioimpedance spectroscopy in Asian dialysis patients (ABISAD-III): a randomized controlled trial for clinical outcomes // International Urology and Nephrology. 2016;48(11):1897–1909. doi: 10.1007/s11255-016-1415-8
9. Malin J, Khan R, Martinez Manzano JM, Wattanachayakul P, et al. Association of arteriovenous fistulae with precapillary pulmonary hypertension: a single center retrospective analysis of invasive hemodynamic parameters // Heart & Lung. 2024;68:260–264. doi: 10.1016/j.hrtlng.2024.08.007
10. Loutradis C, Sarafidis PA, Ekart R, Papadopoulos C, et al. The effect of dry-weight reduction guided by lung ultrasound on ambulatory blood pressure in hemodialysis patients: a randomized controlled trial // Kidney International. 2019;95(6):1505–1513. doi: 10.1016/j.kint.2019.02.018