Shahroud University of Medical Sciences Shahroud Journal of Medical Sciences 2423-6594 12 2 2026 05 02 The Effect of Improved Hemodialysis Adequacy on Primary Pulmonary Hypertension in End Stage Renal Disease Patients 19 23 eng Saeed Rashidi Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran. Monire Amerian Department of Nephrology, Imam Hossain Center for Education, Research and Treatment, Shahroud University of Medical Sciences, Shahroud, Iran. Houfar Rafiee Department of Nephrology, Imam Hossain Center for Education, Research and Treatment, Shahroud University of Medical Sciences, Shahroud, Iran. Kamran Pourmand Department of Cardiology, Imam Hossain Center for Education, Research and Treatment, Shahroud University of Medical Sciences, Shahroud, Iran. Naeimeh Taherian Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran. Shahin Ariya Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran. 2025 05 28 2025 10 22 Background: Hemodialysis serves as a vital life-support therapy that balances electrolytes and fluid levels while eliminating toxic substances from the body, thereby enabling patient survival. Enhanced dialysis efficacy is directly linked to a reduction in uremic complications and a decrease in mortality rates. Pulmonary hypertension (PH) represents a progressive condition stemming from cardiovascular, pulmonary, or systemic disorders, which is characterized by elevated morbidity and death risks. It is hypothesized that optimizing the quality of dialysis may mitigate PH. Consequently, this research was designed to assess how enhancing dialysis adequacy impacts pulmonary artery pressure (PAP) in hemodialysis patients residing in Shahroud. Methods: Employing a descriptive-analytic and longitudinal design, this study was carried out in 2023 at Imam Hossein Hospital, Shahroud, involving patients undergoing hemodialysis. Initially, an expert cardiologist utilized two-dimensional color Doppler echocardiography to determine systolic PAP. These measurements were taken the day following a dialysis session. Additionally, metrics regarding dialysis adequacy were documented for all participants. Subsequently, after a six-month interval during which specific interventions were implemented to boost dialysis adequacy, the patients underwent a repeat echocardiographic evaluation. The resulting PAP values were then analyzed and compared with the baseline data. Results: The study cohort comprised 55 individuals, among whom 37 achieved adequate dialysis levels, while 18 were categorized as having insufficient dialysis. The average age of the participants was 56.62±16.78 years, a figure that remained statistically consistent across the groups. In terms of gender distribution, the population included 32 males (58.2%) and 23 females (41.8%). The overall mean PAP was recorded at 30±13 mmHg. Specifically, 28 subjects (50.9%) exhibited normal PAP levels, whereas the remaining 27 (49.1%) presented with elevated pressure. At the baseline assessment, 15 patients (83.3%) within the insufficient dialysis group demonstrated increased PAP. However, by the conclusion of the study—and following interventions to optimize dialysis adequacy—this number decreased to 12 patients (66.7%), representing a statistically significant reduction (P-value = 0.001). Conclusion: The findings indicate that enhancing the adequacy of dialysis leads to a substantial reduction in PAP and contributes to the improvement of the quality of life for patients undergoing hemodialysis. Keywords: Hemodialysis, Pulmonary hypertension, Dialysis adequacy.