Effect of Chronic Renal Failure on Respiratory Muscle Strength

Bark, Hylton; Heimer, Dov; Chaimovitz, Cidio; Mostoslovski, Marcus

doi:10.1159/000195516

Cited by 46 publications

(48 citation statements)

References 9 publications

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“…In fact, in two studies, it was demonstrated that CRF patients have significantly decreased respiratory muscle strength. (4,5) In another study, MIP was also found to be decreased after hemodialysis sessions. (19) The results of those studies were not replicated in our study, possibly due to differences in duration of hemodialysis.…”

Section: Discussionmentioning

confidence: 89%

“…(4) When compared to healthy individuals, CRF patients also present decreased endurance and decreased respiratory muscle strength. (4,5) In addition to decreased pulmonary function and decreased respiratory muscle strength, CRF patients on hemodialysis present weight fluctuation due to body fluid overload in the interdialytic period. (6) This overload, together with a potential increase in pulmonary capillary permeability, can result in pulmonary edema and pleural effusion, (7,8) abnormalities that could explain-at least in part-the decrease in pulmonary function.…”

Section: Introductionmentioning

confidence: 99%

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Função pulmonar e força muscular respiratória em pacientes com doença renal crônica submetidos à hemodiálise

et al. 2008

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Objective: To evaluate pulmonary function and respiratory muscle strength in chronic renal failure patients, correlating these variables with hemodialysis-related weight fluctuation; to study the correlation between the duration of hemodialysis and potential respiratory alterations. Methods: Seventeen patients (median age, 47 years; interquartile range, 41-52 years), submitted to three weekly hemodialysis sessions for a median of 27 months (interquartile range, 14-55) were evaluated. Twelve of the patients were male. The patients underwent spirometry. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured prior to and after the first hemodialysis session of the week. Body weight was quantified prior to and after each of the three weekly sessions. Results: Before the first hemodialysis session of the week, 8 patients presented mild restrictive defect, which normalized after the session in 2 of those patients. After dialysis, there was a significant increase in forced vital capacity (p = 0.02) and a significant decrease in body weight (p = 0.0001). Weight fluctuation over 3 days without hemodialysis tended to correlate with the variation in forced vital capacity in the first weekly session (r = 0.47; p = 0.055). Duration of hemodialysis correlated with predialysis MIP (r = −0.3; p = 0.03) and MEP (r = −0.63; p = 0.006). Conclusions: More pronounced weight gain in the interdialytic period is associated with worsening of lung function, which is almost fully reversible by hemodialysis. In addition, longer duration of hemodialysis is associated with decreased respiratory muscle strength.Keywords: Spirometry; Respiratory muscles/physiopathology; Kidney failure, chronic; Renal dialysis. ResumoObjetivo: 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 = −...

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Função pulmonar e força muscular respiratória em pacientes com doença renal crônica submetidos à hemodiálise

et al. 2008

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“…Consequently, pharyngeal narrowing in ESRD patients may be related to reduced lung volume, as reflected by the smaller observed ERV (table 4). Respiratory muscle weakness has been described in patients with ESRD [22], which could decrease FRC by reducing chest wall expansion. Alternatively, FRC may be reduced by pulmonary oedema associated with fluid overload, which is common in ESRD.…”

Section: Discussionmentioning

confidence: 99%

Pharyngeal narrowing in end-stage renal disease: implications for obstructive sleep apnoea

Beecroft¹,

Hoffstein²,

Pierratos³

et al. 2007

Eur Respir J

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Sleep apnoea is common in patients with end-stage renal disease (ESRD). It was hypothesised that this is related to a narrower upper airway. Upper airway dimensions in patients with and without ESRD and sleep apnoea were compared, in order to determine whether upper airway changes associated with ESRD could contribute to the development of sleep apnoea.An acoustic reflection technique was used to estimate pharyngeal cross-sectional area. Sleep apnoea was assessed by overnight polysomnography. A total of 44 patients with ESRD receiving conventional haemodialysis and 41 subjects with normal renal function were studied. ESRD and control groups were further categorised by the presence or absence of sleep apnoea (apnoea/ hypopnoea index o10 events?h -1 ). The pharyngeal area was smaller in patients with ESRD compared with subjects with normal renal function: 3.04¡0.84 versus 3.46¡0.80 cm 2 for the functional residual capacity and 1.99¡0.51 versus 2.14¡0.58 cm 2 for the residual volume. The pharynx is narrower in patients with ESRD than in subjects with normal renal function.In conclusion, since a narrower upper airway predisposes to upper airway occlusion during sleep, it is suggested that this factor contributes to the pathogenesis of sleep apnoea in dialysisdependent patients.

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“…Some studies 33,35 have reported that patients with CKD showed significantly reduced PI max , but a significant improvement of that pressure was observed after HD. Those results are partially in accordance with those obtained in the present investigation, in which a significant impairment in PI max values was observed in patients with CKD as compared with those in a normal population.…”

Section: Mean ±Standard Error ±Sd Mean ±Standard Error ±Sdmentioning

confidence: 98%

Avaliação das pressões respiratórias máximas em pacientes renais crônicos nos momentos pré e pós-hemodiálise

Rocha

Araújo

2010

J. Bras. Nefrol.

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Introduction and Objective: Maximal inspiratory and expiratory pressures (PI max and PE max ) are used to assess the integrity of respiratory muscles by measuring their strength. The aim of this study was to assess the immediate influence of hemodialysis (HD) on respiratory muscle strength by measuring PI max and PE max , investigating the integrity of that musculature and/or the presence of muscular weakness. Method: A prospective, crosssectional study was carried out on a convenience sample of 35 patients with chronic kidney disease (26 men and 9 women; mean age, 51.7 ± 14.7 years) at the Nephrology Division of the Hospital Universitário Alzira Vellano, in the city of Alfenas, in the state of Minas Gerais, Brazil. Patients had their PI max and PE max taken in the seated position (at 90°) by using a digital manovacuometer (MVD 300®) attached to a notebook for reading and recording data obtained before and after the HD session. Results: Both PI max and PE max were lower than the values predicted for pre-and post-HD (p < 0.0001). Comparing the values obtained pre-HD and post-HD, PImax showed a slight improvement (p = 0.0420), evidenced only in patients with pre-HD values below 60 cmH 2 O (Wilcoxon; p = 0.0480). Post-HD PE max did not differ from the pre-HD measure (p = 0.4987). Conclusion: The CKD patients showed a serious impairment of their respiratory muscle function, and only one isolated HD session could not significantly improve their maximum respiratory pressures. A slight improvement in the inspiratory strength was observed in patients whose PI max was lower than 60 cm-H 2 O before the procedure.

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Effect of Chronic Renal Failure on Respiratory Muscle Strength

Cited by 46 publications

References 9 publications

Função pulmonar e força muscular respiratória em pacientes com doença renal crônica submetidos à hemodiálise

Função pulmonar e força muscular respiratória em pacientes com doença renal crônica submetidos à hemodiálise

Pharyngeal narrowing in end-stage renal disease: implications for obstructive sleep apnoea

Avaliação das pressões respiratórias máximas em pacientes renais crônicos nos momentos pré e pós-hemodiálise

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