الفهرس 
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Abstract
Excess mortality rates due to cardiovascular disease in end- stage renal disease (ESRD) patients was described by many epidemiological and clinical studies.. Pulmonary hypertension is a Patho-physiological disorder that involves multiple clinical conditions and can complicate many cardiovascular and respiratory diseases .
The aim of our study was to evaluate the effect of sildenafil on pulmonary artery pressure in hemodialysis patients with pulmonary hypertension by measuring the reduction in estimated Pulmonary Artery pressure value (ePAP) via transthoracic Doppler Echocardiography and evaluate clinical improvement via six minute walk test (6MWT).
We also aim to detect safety of sildenafil in hemodialysis patients and finding out sildenafil’s optimum dose for hemodialysis patients with pulmonary hypertension .
This study was conducted between January and May of 2019 on 60 hemodialysis patient divided randomly to 3 groups : group 1 (n=19) received 25 mg sildenafil for 3 months with age mean of (52.6±10.8) , this group had 12 male (63%) and 7 female (37%) with median duration of HD of 4 years.
group 2 (n=18) received 50 mg sildenafil for 3 months with age mean of (45.5±12.1), this group had 9 male (50%) and 9 female (50%) with median duration of HD of 2 years.
group 3 (n=19) received placebo for 3 months with age mean of (52.2±7), this group had 12 male (63%) and 7 female (37%) with median duration of HD of 2.5 years
We excluded from the study any patient with current treatment of pulmonary hypertension, history of heart diseases (congestive heart failure, ischemic heart disease, and congenital heart disease), Lung diseases (chronic obstructive pulmonary disease, pulmonary thromboemboli or tumor, interstitial lung diseases, sleep apnea, pulmonary fibrosis, Sarcoidosis) and collagen or autoimmune diseases (scleroderma, systemic lupus erythematosus).
There were 1 DROP out from group 1 due to non-compliance,
2 DROP outs from group 2 due to sildenafil side effect (hypotension
and headache ) and one DROP out from group 3 due to road traffic accident.
We observed statistically significant increase in 6MWT done after treatment in group 1 (P<.001), group 2 also had significant increase (P<.001). However group 3 (placebo) shows no statistically significant difference after treatment.
By Post- Hoc analysis group 2 (sildenafil 50mg) showed significant increase in (6MWT) in comparison to group 1 (sildenafil
25mg) (P<0.05) and highly significant increase in comparison to group 3 (receiving placebo) (P<0.001), which indicated that dose of 50mg sildenafil may be more effective than 25mg sildenafil in improving clinical condition and increase patient functional exercise capacity.
In group 1( Sildenafil 25 mg ) there was a significant decrease in e PAP mean after treatment (P<0.001) , this group at the begging of the study had 16% of the patient suffered mild PH, 68% had moderate PH and 16% severe PH. After treatment 7 patients (37%) downgraded from moderate PH to mild PH , 2 patients (10%) downgraded from severe to mild PH .
group 2 (sildenafil 50mg) showed significant decrease in e PAP mean after treatment(P<0.001) , this group at the begging of the study had 45% of the patient suffered mild PH, 33% had moderate PH and 22% severe PH. After treatment 4 patients (22%) downgraded from moderate PH to mild PH , 2 patients (11%) downgraded from severe to mild PH .
In group 3 (placebo ) there were 37 % with mild PH , 58%
suffered moderate PH and 5% had severe PH, after treatment only
5% downgraded from moderate to severe .
There were 2 DROP outs from the study from group 2 (sildenafil 50 mg ) due to sildenafil related side effects appeared through the study, the first one suffered from persistent headache and the other patients suffered from hypotension and dizziness.