This prospective multicenter longitudinal study aims to investigate the prevalence, pathogenesis, and prognosis of pulmonary hypertension in patients with end-stage renal disease undergoing chronic hemodialysis. The research seeks to identify specific clinical factors and biomarkers like angiopoietin-2 that contribute to the development of this condition, while evaluating the prognostic value of right ventricular function measured via TAPSE. Participants undergo a standardized screening echocardiogram the day after their intermediate dialysis session to determine the probability of pulmonary hypertension. Those identified as high-risk receive further diagnostic confirmation through right heart catheterization, respiratory function tests, and lung scans to clarify the underlying etiology. The protocol also evaluates the hemodynamic impact of high-flow arteriovenous fistulas and volume overload on pulmonary pressures. Clinical follow-up is conducted at baseline and subsequently at 6, 12, and 24 months to monitor patient outcomes and standardize therapeutic management according to established European guidelines.

Inclusion Criteria:

• Patients aged between 18 and 75 years
• Patients on stable extracorporeal hemodialysis for at least 6 months
• Dialysis frequency of two or three times per week
• Ability to provide written informed consent

Exclusion Criteria:

• WHO functional class IV
• Presence of valvular or congenital heart disease
• Acute infections within the month preceding the cardiological evaluation

The study population consists of adult patients (18-75 years old) with end-stage renal disease who have been receiving stable extracorporeal hemodialysis for at least six months at participating multicenter dialysis units.