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Srithongkul T, Lyons OD, Faratro R, Chan CT. Changes in pulmonary restrictive parameters by intensive home hemodialysis: a case report. BMC Nephrol 2020; 21:322. [PMID: 32746797 PMCID: PMC7397629 DOI: 10.1186/s12882-020-01977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 07/22/2020] [Indexed: 11/29/2022] Open
Abstract
Background Patients with End-Stage Renal Disease (ESRD) are at an increased risk for restrictive lung disease due to accumulation of uremic toxins and volume overload. Hemodialysis is the preferred treatment for improving lung function in dialysis patients. However, the effects of fluid removal and solute clearance by hemodialysis on lung function remain unclear. Case presentation We report a case of restrictive lung disorder in a hemodialysis patient, who showed improvement in both clinical and spirometric lung function after initiation of intensive home hemodialysis (32 h per week). Conclusion Intensive hemodialysis augments fluid removal and solute clearance, which in turn may improve restrictive lung function.
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Affiliation(s)
- Thatsaphan Srithongkul
- Division of Nephrology, University of Toronto, 200 Elizabeth Street, 8N room 846, Toronto, ON, M5G 2C4, Canada.,University Health Network, Toronto, Canada.,Department of Medicine, Siriraj Hospital, Mahidol University, Nakhon Pathom, Thailand
| | - Owen D Lyons
- Department of Medicine, Women's College Hospital, Toronto, ON, Canada
| | | | - Christopher T Chan
- Division of Nephrology, University of Toronto, 200 Elizabeth Street, 8N room 846, Toronto, ON, M5G 2C4, Canada. .,University Health Network, Toronto, Canada.
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Sharma A, Sharma A, Gahlot S, Prasher PK. A study of pulmonary function in end-stage renal disease patients on hemodialysis: a cross-sectional study. SAO PAULO MED J 2017; 135:568-572. [PMID: 29267516 PMCID: PMC10016016 DOI: 10.1590/1516-3180.2017.0179150817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/15/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD) patients. DESIGN AND SETTING Prospective study in tertiary-level care center. METHODS Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions. RESULTS The patients' average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94%) and hypoalbuminemia (72%) were common. Diabetes mellitus (68%), hypertension (34%) and coronary artery disease (18%) were major comorbidities. Forty-five patients (90%) had been on hemodialysis for six months to three years. The patients' pre-dialysis mean forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P < 0.01). The increase in mean FEV1/FVC, from 97.8 ± 20.8% to 99.3 ± 20.1% of predicted, was not significant (P > 0.05). The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05). The mean peak expiratory flow was below normal (43.8 ± 30.7%) and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05). Males and females showed similar directions of change after hemodialysis. CONCLUSIONS Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved.
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Affiliation(s)
- Ashima Sharma
- MD. Senior Resident, Department of Physiology, Indira Gandhi Medical College, Shimla, India.
| | - Ashok Sharma
- MD. Professor, Department of Medicine, Indira Gandhi Medical College, Shimla, India.
| | - Sushila Gahlot
- MD. Professor, Department of Physiology, Gian Sagar Medical College & Hospital, Ramnagar, Patiala. India
| | - Pawan Kumar Prasher
- MD, DM. Professor, Department of Medicine, Gian Sagar Medical College & Hospital, Ramnagar, Patiala. India
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Yılmaz S, Yildirim Y, Yilmaz Z, Kara AV, Taylan M, Demir M, Coskunsel M, Kadiroglu AK, Yilmaz ME. Pulmonary Function in Patients with End-Stage Renal Disease: Effects of Hemodialysis and Fluid Overload. Med Sci Monit 2016; 22:2779-84. [PMID: 27497672 PMCID: PMC4979594 DOI: 10.12659/msm.897480] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Respiratory system disorders are one of the most prevalent complications in end-stage renal disease patients on hemodialysis. However, the pathogenesis of impaired pulmonary functions has not been completely elucidated in these patients. We designed a study to investigate acute effects of hemodialysis treatment on spirometry parameters, focusing on the relationship between pulmonary function and fluid status in hemodialysis patients. Material/Methods We enrolled 54 hemodialysis patients in this study. Multifrequency bioimpedance analysis (BIA) was used to assess fluid status before and 30 min after the midweek of hemodialysis (HD). Overhydration (OH)/extracellular water (ECW)% ratio was used as an indicator of fluid status. Fluid overload was defined as OH/ECW ≥7%. Spirometry was performed before and after hemodialysis. Results Forced vital capacity (FVC), FVC%, and forced expiratory volume in the first second (FEV1) levels were significantly increased after hemodialysis. FVC, FVC%, FEV1, FEV1%, mean forced expiratory flow between 25% and 75% of the FVC (FEF25–75), FEF25–75%, peak expiratory flow rate (PEFR), and PEFR% were significantly lower in patients with fluid overload than in those without. OH/ECW ratio was negatively correlated with FVC, FVC%, FEV1, FEV1%, FEF25–75, FEF25–75%, PEFR, and PEFR%. Stepwise multiple regression analysis revealed that male sex and increased ultrafiltration volume were independently associated with higher FVC, whereas increased age and OH/ECW ratio were independently associated with lower FVC. Conclusions Fluid overload is closely associated with restrictive and obstructive respiratory abnormalities in HD patients. In addition, hemodialysis has a beneficial effect on pulmonary function tests, which may be due to reduction of volume overload.
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Affiliation(s)
- Süreyya Yılmaz
- Department of Chest Diseases and Tuberculosis, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Yasar Yildirim
- Department of Nephrology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Zülfükar Yilmaz
- Department of Nephrology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Ali Veysel Kara
- Department of Nephrology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Mahsuk Taylan
- Department of Chest Diseases and Tuberculosis, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Melike Demir
- Department of Chest Diseases and Tuberculosis, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Mehmet Coskunsel
- Department of Chest Diseases and Tuberculosis, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Ali Kemal Kadiroglu
- Department of Nephrology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Mehmet Emin Yilmaz
- Department of Nephrology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
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Plesner LL, Warming PE, Nielsen TL, Dalsgaard M, Schou M, Høst U, Rydahl C, Brandi L, Køber L, Vestbo J, Iversen K. Chronic obstructive pulmonary disease in patients with end-stage kidney disease on hemodialysis. Hemodial Int 2015; 20:68-77. [DOI: 10.1111/hdi.12342] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Louis L. Plesner
- Department of Cardiology; Herlev Hospital, Copenhagen University Hospital; Copenhagen Denmark
- Department of Cardiology, Endocrinology and Nephrology; Nordsjaellands Hospital, Copenhagen University Hospital; Copenhagen Denmark
| | - Peder E. Warming
- Department of Cardiology; Herlev Hospital, Copenhagen University Hospital; Copenhagen Denmark
- Department of Cardiology, Endocrinology and Nephrology; Nordsjaellands Hospital, Copenhagen University Hospital; Copenhagen Denmark
| | - Ture L. Nielsen
- Department of Cardiology, Endocrinology and Nephrology; Nordsjaellands Hospital, Copenhagen University Hospital; Copenhagen Denmark
| | - Morten Dalsgaard
- Department of Cardiology; Herlev Hospital, Copenhagen University Hospital; Copenhagen Denmark
| | - Morten Schou
- Department of Cardiology; Herlev Hospital, Copenhagen University Hospital; Copenhagen Denmark
| | - Ulla Høst
- Department of Cardiology; Herlev Hospital, Copenhagen University Hospital; Copenhagen Denmark
| | - Casper Rydahl
- Department of Nephrology; Herlev Hospital, Copenhagen University Hospital; Copenhagen Denmark
| | - Lisbet Brandi
- Department of Cardiology, Endocrinology and Nephrology; Nordsjaellands Hospital, Copenhagen University Hospital; Copenhagen Denmark
| | - Lars Køber
- Department of Cardiology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Jørgen Vestbo
- Department of Respiratory Medicine; Gentofte Hospital, Copenhagen University Hospital; Copenhagen Denmark
- Respiratory and Allergy Research Group; Manchester Academic Health Science Centre; University Hospital South Manchester NHS Foundation Trust; Manchester UK
| | - Kasper Iversen
- Department of Cardiology; Herlev Hospital, Copenhagen University Hospital; Copenhagen Denmark
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Elsayed ME, Stack AG. What are the Consequences of Volume Expansion in Chronic Dialysis Patients? Semin Dial 2015; 28:235-9. [DOI: 10.1111/sdi.12351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mohamed E. Elsayed
- Departments of Nephrology and Internal Medicine; University Hospital Limerick; Limerick Ireland
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
| | - Austin G. Stack
- Departments of Nephrology and Internal Medicine; University Hospital Limerick; Limerick Ireland
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
- Health Research Institute; University of Limerick; Limerick Ireland
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Kosmadakis G, Aguilera D, Carceles O, Da Costa Correia E, Boletis I. Pulmonary Hypertension in Dialysis Patients. Ren Fail 2013; 35:514-20. [DOI: 10.3109/0886022x.2013.766559] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kiykim AA, Horoz M, Ozcan T, Yildiz I, Sari S, Genctoy G. Pulmonary hypertension in hemodialysis patients without arteriovenous fistula: the effect of dialyzer composition. Ren Fail 2010; 32:1148-52. [DOI: 10.3109/0886022x.2010.516854] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dipp T, Silva AMVD, Signori LU, Strimban TM, Nicolodi G, Sbruzzi G, Moreira PR, Plentz RDM. Força muscular respiratória e capacidade funcional na insuficiência renal terminal. REV BRAS MED ESPORTE 2010. [DOI: 10.1590/s1517-86922010000400002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Verificar a associação da força muscular respiratória com a capacidade funcional, força proximal de membros inferiores e variáveis bioquímicas em pacientes em hemodiálise (HD). MÉTODOS: Participaram deste estudo 30 indivíduos (18 homens), com 53,4 ± 12,9 anos e tempo de HD de 41,1 ± 55,7 meses. Foram avaliados pressão inspiratória máxima (PImax), pressão expiratória máxima (PEmax), distância percorrida no teste de caminhada de seis minutos (6MWT), número de repetições no teste de sentar-e-levantar em 30 segundos (TSL) e registrados os exames bioquímicos de rotina no serviço. RESULTADOS: Houve diminuição da PEmax em relação aos valores preditos (p = 0,015) e redução na distância percorrida no 6MWT quando comparados com equações de predição (p < 0,001). O logPImax e o logPEmax correlacionaram-se com o número de repetições no TSL (r = 0,476, p = 0,008; r = 0,540, p = 0,002, respectivamente), e com os níveis séricos de fósforo (r = 0,422, p = 0,020; r = 0,639, p < 0,001, respectivamente). A distância no 6MWT correlacionou-se com o logPEmax (r = 0,511; p = 0,004) e com o número de repetições no TSL (r = 0,561; p = 0,001). CONCLUSÃO: A redução da PEmax em pacientes com IRT em HD está associada à capacidade funcional, força proximal de membros inferiores e níveis de fósforo sérico, podendo representar, pelo menos em parte, o baixo desempenho físico-funcional desses pacientes.
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Kovelis D, Pitta F, Probst VS, Peres CPA, Delfino VDA, Mocelin AJ, Brunetto AF. Função pulmonar e força muscular respiratória em pacientes com doença renal crônica submetidos à hemodiálise. J Bras Pneumol 2008; 34:907-12. [DOI: 10.1590/s1806-37132008001100004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 03/06/2008] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a função pulmonar e a força muscular respiratória de pacientes com doença renal crônica e correlacioná-las com a variação de peso ligada à realização de hemodiálise; estudar a correlação entre o tempo de hemodiálise e possíveis alterações respiratórias. MÉTODOS: Foram avaliados 17 pacientes (mediana de idade, 47 anos; intervalo interquartílico, 41-52 anos) submetidos a três sessões semanais de hemodiálise (mediana de tempo, 27 meses; intervalo interquartílico, 14-55). Doze eram do sexo masculino. Realizaram espirometria e mensuração das pressões máximas inspiratória (PImáx) e expiratória (PEmáx) antes e após a primeira sessão semanal de hemodiálise. O peso corporal foi quantificado antes e após as três sessões semanais. RESULTADOS: Oito pacientes apresentaram distúrbio restritivo leve antes da primeira sessão de hemodiálise. Desses, 2 normalizaram após a sessão. Houve aumento da capacidade vital forçada (p = 0,02) e diminuição de peso (p = 0,0001) ao final da primeira sessão semanal. A variação de peso durante três dias sem hemodiálise tendeu a se correlacionar com a variação da capacidade vital forçada na primeira sessão (r = 0,47; p = 0,055). O tempo de hemodiálise correlacionou-se com os valores da porcentagem do predito da PImáx (r = -0,53; p = 0,03) e com a PEmáx (r = -0,63; p = 0,006) pré-diálise. CONCLUSÕES: O maior ganho de peso no período interdialítico está associado com a piora da função pulmonar, que pode ser quase totalmente revertida com hemodiálise. Além disso, o maior tempo de hemodiálise está associado à diminuição da força muscular respiratória.
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Latchford K, Cowperthwaite J. Shortness of breath during dialysis--a role of bicarbonate in dialysis fluid? J Ren Care 2008; 34:2-4. [PMID: 18336515 DOI: 10.1111/j.1755-6686.2008.00002.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Occasionally dialysis patients show symptoms that indicate intolerance in the way dialysis is delivered. This paper describes two cases of transient shortness of breath during the initial treatments after starting online haemodiafiltration (HDF). Our actions to deal with these symptoms focused on reducing the bicarbonate gain during the first phase of the dialysis treatment. As the symptoms gradually disappeared we hypothesise that the bicarbonate concentration in the dialysis fluid may play an important role for the development of shortness of breath and hypoxemia during HDF treatments.
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Steinhorst RC, Vieira JM, Abdulkader RCRM. Acute effects of intermittent hemodialysis and sustained low-efficiency hemodialysis (SLED) on the pulmonary function of patients under mechanical ventilation. Ren Fail 2008; 29:341-5. [PMID: 17497449 DOI: 10.1080/08860220701389922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The effects of hemodialysis (HD) on pulmonary function are still controversial. The objective of this study was to evaluate the effect of intermittent hemodialysis (IHD) and sustained low-efficiency dialysis (SLED) on the respiratory mechanics of ICU patients under invasive mechanical ventilation. We prospectively studied 31 patients. Laboratory and respiratory evaluation (static and dynamic compliance and resistance) was performed pre- and post-HD. Forty HD sessions were studied and grouped in: SLED (n = 17; Qa = 200-250 mL/min, Qd = 300 mL/min) and IHD (n = 23; Qa = 250-300 mL/min, Qd = 500 mL/min). There was no difference between the groups according to age, gender, comorbidities, APACHE II, and cause of mechanical ventilation, but pre-HD, patients in the IHD group had higher levels of plasma creatinine (5.4 +/- 2.0 vs. 4.2 +/- 1.3 mg/dL, p = 0.048) and platelets (286 +/- 186 vs. 174 +/- 95 10(3)/mm(2), p = 0.032) and lower arterial pH (7.37 +/- 0.07 vs. 7.42 +/- 0.05, p = 0.02). The efficiency of the treatment was similar (p > 0.05) with both types of HD regarding fluid removal, urea reduction rate, and decrease in plasma creatinine. Pre-HD, the ventilatory conditions of both groups were similar (p > 0.05) except for pressure support ventilation and airflow resistance. There were no changes (pre- versus post-HD p > 0.05) induced either by IHD or SLED in the ratio PaO(2)/FiO(2) or in any measured ventilatory parameter. In conclusion, neither IHD nor SLED modifies the pulmonary function of patients under mechanical ventilation.
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Affiliation(s)
- Renata Campos Steinhorst
- Division of Nephrology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
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Buemi M, Senatore M, Gallo G, Crascì E, Campo S, Sturiale A, Coppolino G, Bolignano D, Frisina N. Pulmonary Hypertension and Erythropoietin. Kidney Blood Press Res 2007; 30:248-52. [DOI: 10.1159/000104443] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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