Pulmonary Function in Patients with End-Stage Renal Disease: Effects of Hemodialysis and Fluid Overload

Abstract

BackgroundRespiratory 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/MethodsWe 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.ResultsForced 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.ConclusionsFluid 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.

Effects of respiratory muscle training on endothelium and oxidative stress biomarkers in hemodialysis patients: A randomized clinical trial

“…Patients undergoing maintenance hemodialysis have decreased pulmonary function [22,23].In addition to interdialytic fluid accumulation and potential increase in pulmonary capillary permeability, respiratory muscle impairment can explain this reduced pulmonary function [24]. The effects of muscle respiratory training on the rehabilitation of patients with COPD or other lung diseases are largely known [25,26]; however, there is insufficient data about the effects on populations without primary lung disease.…”

Early Effects of Hemodialysis on Pulmonary Function in Patients with End-Stage Renal Disease

“…Almost all systems of the body are adversely affected by ESRD, such as respiratory, cardiovascular, and metabolic systems. The respiratory system is affected by ESRD complications and hemodialysis treatment (5).…”

“…Unfortunately, the prevalence of ESRD is rising along with the increase in diabetes, hypertension, and obesity (21). In ESRD patients, all the body systems are affected, and they suffer from serious respiratory, coronary, and metabolic complications (5,9).…”

“…Chronic kidney disease (CKD) is considered one of the main global health issues due to its high prevalence, progression to end-stage renal disease (ESRD), and early death (1)(2)(3)(4). CKD emanates from various renal damages and is an irreversible, progressive disease that may progress gradually and lead to the loss of renal function and ESRD (5). The accumulation of toxins, liquids, and electrolytes due to the decreased glomerular filtration will lead to the uremic syndrome or patient's death if it is not treated effectively with renal replacement therapies such as hemodialysis, peritoneal dialysis, or kidney transplantation (6).…”

“…The accumulation of toxins, liquids, and electrolytes due to the decreased glomerular filtration will lead to the uremic syndrome or patient's death if it is not treated effectively with renal replacement therapies such as hemodialysis, peritoneal dialysis, or kidney transplantation (6). In spite of increased life expectancy due to dialysis technologies, patients' problems, especially those related to systemic or metabolic complications and hemodialysis complications, have increasingly grown (5,7,8). The lungs' mechanical function and ventilation are associated with the kidneys' function in normal and disease conditions (9).…”