Pulmonary hypertension (PH) is common in patients with chronic kidney disease (CKD) or kidney failure, with an estimated prevalence of up to 78% in those referred for right-heart catheterization. PH is independently associated with adverse outcomes in CKD, raising the possibility that early detection and appropriate management of PH might improve outcomes in at-risk patients. Among patients with PH, the prevalence of CKD stages 3 and 4 is estimated to be as high as 36%, and CKD is also independently associated with adverse outcomes. However, the complex, heterogenous pathophysiology and clinical profile of CKD–PH requires further characterization. CKD is often associated with elevated left ventricular filling pressure and volume overload, which presumably leads to pulmonary vascular stiffening and post-capillary PH. By contrast, a distinct subgroup of patients at high risk is characterized by elevated pulmonary vascular resistance and right ventricular dysfunction in the absence of pulmonary venous hypertension, which may represent a right-sided cardiorenal syndrome defined in principle by hypervolaemia, salt avidity, low cardiac output and normal left ventricular function. Current understanding of CKD–PH is limited, despite its potentially important ramifications for clinical decision making. In particular, whether PH should be considered when determining the suitability and timing of kidney replacement therapy or kidney transplantation is unclear. More research is urgently needed to address these knowledge gaps and improve the outcomes of patients with or at risk of CKD–PH.

肺动脉高压 （PH） 在慢性肾病 （CKD） 或肾衰竭患者中很常见，在转诊接受右心导管插入术的患者中，估计患病率高达 78%。PH 与 CKD 的不良结局独立相关，这增加了 PH 的早期检测和适当管理可能会改善高危患者预后的可能性。在 PH 患者中，CKD 3 期和 4 期的患病率估计高达 36%，并且 CKD 也与不良结局独立相关。然而，CKD-PH 复杂、异质的病理生理学和临床特征需要进一步表征。CKD 通常与左心室充盈压升高和容量超负荷有关，这可能导致肺血管硬化和毛细血管后 PH。相比之下，一个明显的高危患者亚组的特征是肺血管阻力升高和右心室功能障碍，而没有肺静脉高压，这可能代表右心肾综合征，原则上定义为高血容量、嗜盐性、低心输出量和正常的左心室功能。目前对 CKD-PH 的理解是有限的，尽管它对临床决策有潜在的重要影响。特别是，在确定肾脏替代疗法或肾移植的适用性和时机时是否应考虑 PH 尚不清楚。迫切需要更多的研究来解决这些知识差距并改善 CKD-PH 患者或有 CKD-PH 风险的患者的预后。