Subcutaneous treprostinil was effective and tolerable in a patient with severe pulmonary hypertension associated with chronic kidney disease on hemodialysis

Takanori Watanabe; Kohtaro Abe; Koshin Horimoto; Kazuya Hosokawa; Kisho Ohtani; Hiroyuki Tsutsui

doi:10.1016/j.hrtlng.2017.01.004

Subcutaneous treprostinil was effective and tolerable in a patient with severe pulmonary hypertension associated with chronic kidney disease on hemodialysis

Heart Lung. 2017 Mar-Apr;46(2):129-130. doi: 10.1016/j.hrtlng.2017.01.004. Epub 2017 Feb 9.

Authors

Takanori Watanabe¹, Kohtaro Abe², Koshin Horimoto¹, Kazuya Hosokawa¹, Kisho Ohtani¹, Hiroyuki Tsutsui¹

Affiliations

¹ Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan.
² Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan. Electronic address: koabe@cardiol.med.kyushu-u.ac.jp.

PMID: 28189266
DOI: 10.1016/j.hrtlng.2017.01.004

Abstract

Background: Pulmonary hypertension (PH) is a life-threatening complication in patients with chronic kidney disease on hemodialysis (CKD-HD).

Objectives: To determine whether subcutaneous infusion of treprostinil was effective and tolerable CKD-PH.

Methods and results: A 57-year-old man was admitted to our hospital due to presyncope and dyspnea during exercise with a history of CKD-HD. Cardiac catheterization revealed high pulmonary arterial pressure (PAP) of 53/24/32 mmHg and pulmonary vascular resistance (PVR) of 11.2 w.u. Upfront combination therapy with bosentan and sildenafil was started. However, 6-month therapy did not attenuate his symptoms, probably due to the high PAP and PVR (60/19/30 mmHg and 5.9 w.u.). We added subcutaneous treprostinil. Surprisingly, 9-month treprostinil (50 ng/kg/min) normalized hemodynamics (PAP: 25/4/13 mmHg and PVR: 1.9 w.u.). His symptoms during excise disappeared without any adverse effects.

Conclusion: This is the first report that subcutaneous treprostinil was very effective and tolerable in a PH patient with CKD-HD.

Keywords: Chronic kidney disease; Hemodialysis; Infection; Pulmonary hypertension; Treprostinil.

Publication types

Case Reports

MeSH terms

Antihypertensive Agents / administration & dosage
Dose-Response Relationship, Drug
Drug Tolerance*
Epoprostenol / administration & dosage
Epoprostenol / analogs & derivatives*
Hemodynamics / drug effects*
Humans
Hypertension, Pulmonary / drug therapy*
Hypertension, Pulmonary / etiology
Hypertension, Pulmonary / physiopathology
Injections, Subcutaneous
Male
Middle Aged
Renal Dialysis*
Renal Insufficiency, Chronic / complications*
Renal Insufficiency, Chronic / therapy
Severity of Illness Index

Substances

Antihypertensive Agents
Epoprostenol
treprostinil