Influence of mild pulmonary congestion on diaphragmatic mobility and activities of daily living in chronic kidney disease: An experimental and clinical study

Francisco, Davi de Souza; Peruzzolo, Catherine Corrêa; Moecke, Débora Petry; Yamaguti, Wellington Pereira; Kunzler, Deborah Hizume; Paulin, Elaine

doi:10.1016/j.nefro.2021.12.002

Cited by 3 publications

(1 citation statement)

References 39 publications

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“…We believe that axial skeleton muscles, as well as the appendicular skeletal muscles [ 3 ], may experience impairment not only due to aging, but also due to the presence of chronic diseases, such as CKD, leading to reduced strength and physical performance. In CKD, fluid overload may alter respiratory mechanical properties, particularly reducing pulmonary compliance and the respiratory muscle activity [ 8 , 43 ]. These factors, combined with changes already documented in the literature, such as transient hypoxemia recovered during HD [ 44 ], muscle mass loss [ 29 ], the uremic milieu [46], reduced force of diaphragmatic contraction [ 21 ], chronic inflammatory processes [ 45 ] and the high incidence of cardiovascular diseases [ 10 ], could exacerbate the extent of physical impairment in these patients.…”

Section: Discussionmentioning

confidence: 99%

Respiratory sarcopenia screening in dialysis patients: cross-sectional and multicentre study protocol

Andrade,

Borges,

da Silva Filho

et al. 2024

BMC Nephrol

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Background Respiratory sarcopenia is characterized by the weakness of respiratory muscles associated with sarcopenia due to aging or systemic diseases such as chronic kidney disease (CKD). Patients with CKD undergoing dialysis are particularly susceptible to respiratory muscle weakness caused by factors such as fluid overload and electrolyte imbalance. This weakness not only affects ventilation but also impairs oxygen uptake and delivery to muscle tissue, potentially leading to severe sarcopenia. Thus, the objective of this study is to conduct a respiratory sarcopenia screening in patients with CKD undergoing haemodialysis (HD) and peritoneal dialysis (PD). Methods This is an observational, cross-sectional and multicentre study conducted between March 2023 and March 2025. The study was approved by the Research Ethics Committee at two centres. Sarcopenia diagnosis is determined based on low handgrip strength and amount of appendicular skeletal muscle mass, assessed through bioelectrical impedance analysis. Respiratory sarcopenia is diagnosed in patients with sarcopenia who have low inspiratory muscle strength, evaluated through a manovacuometry test. The severity of sarcopenia and respiratory sarcopenia is defined, respectively, by low physical performance (measured using the Short Physical Performance Battery and Timed-Up and Go test) and pulmonary performance (measured through spirometry). Thus, this study will include 81 patients undergoing dialysis (41 on HD and 40 on PD) from three participating centres. Discussion The literature has been focused on respiratory function in CKD; however, the relationship with sarcopenia remains understudied. We believe that, similar to appendicular skeleton muscles, the axial skeleton muscles are also likely to weaken with the presence of chronic disease, such as CKD.

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Section: Discussionmentioning

confidence: 99%

Respiratory sarcopenia screening in dialysis patients: cross-sectional and multicentre study protocol

Andrade,

Borges,

da Silva Filho

et al. 2024

BMC Nephrol

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Lung-kidney interactions and their role in chronic kidney disease-associated pulmonary diseases

Bollenbecker

Czaya

Gutiérrez

et al. 2022

American Journal of Physiology-Lung Cellular and Molecular Phys

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Chronic illnesses rarely present in a vacuum, devoid of other complications, and chronic kidney disease is hardly an exception. Comorbidities associated with chronic kidney disease lead to faster disease progression, expedited dialysis dependency, and a higher mortality rate. Although chronic kidney disease is most commonly accompanied by cardiovascular diseases and diabetes, there is clear crosstalk between the lungs and kidneys pH balance, phosphate metabolism, and immune system regulation. Our present understanding of the exact underlying mechanisms that contribute to chronic kidney disease-related pulmonary disease are poorly understood. This review summarizes the current research on kidney-pulmonary interorgan crosstalk in the context of chronic kidney disease, highlighting various acute and chronic pulmonary diseases that lead to further complications in patient care. Treatment options for patients presenting with chronic kidney disease and lung disease are explored by assessing activated molecular pathways and the body's compensatory response mechanisms following homeostatic imbalance. Understanding the link between the lungs and kidneys will potentially improve health outcomes for patients and guide healthcare professionals to better understand how and when to treat each of the pulmonary comorbidities that can present with chronic kidney disease.

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The phase angle cut-off point capable of discriminating hemodialysis patients with reduced exercise tolerance: a cross-sectional study

de Souza Francisco,

Moraes,

Brito

et al. 2024

BMC Sports Sci Med Rehabil

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Background Phase angle (PhA) is a prognostic marker of all-cause mortality in chronic kidney disease. However, no study has investigated this marker as a predictor of exercise intolerance in hemodialysis (HD) patients. The aim of this study was to determine a cut-off point for the PhA capable of discriminating HD patients with reduced exercise tolerance. Methods Thirty-one patients (80.6% men, median age 69 years) were included. The evaluations were performed on three different days, before the HD session. The outcomes evaluated were: biochemical markers, inflammatory and nutritional status, body composition, peripheral muscle strength and exercise tolerance. Performance ≤50% of the predicted value in the six-minute step test (6MST) was defined as reduced exercise tolerance. Results Patients presented an average of 67.6 steps (50.5% of predicted) in the 6MST. Fifteen patients (48.4%) were classified with reduced exercise tolerance. The receiver operating characteristic curve indicated a cut-off point of 3.73° for the PhA (sensitivity = 87%, specificity = 81%, and area under the curve = 0.88 [95% CI: 0.76–1.00]; p < 0.001). Patients with reduced exercise tolerance had worse inflammatory and nutritional status, lower PhA and greater impairment of peripheral muscle strength. Conclusion The cut-off point of 3.73° for the PhA is sensitive and specific to discriminate HD patients with reduced exercise tolerance. Trial registration This study was registered in the Clinical Trials database (no. NCT03779126, date of first registration 19/12/2018).

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Influence of mild pulmonary congestion on diaphragmatic mobility and activities of daily living in chronic kidney disease: An experimental and clinical study

Cited by 3 publications

References 39 publications

Respiratory sarcopenia screening in dialysis patients: cross-sectional and multicentre study protocol

Respiratory sarcopenia screening in dialysis patients: cross-sectional and multicentre study protocol

Lung-kidney interactions and their role in chronic kidney disease-associated pulmonary diseases

The phase angle cut-off point capable of discriminating hemodialysis patients with reduced exercise tolerance: a cross-sectional study

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