Relationship Between Pulmonary Functions and Hemodialysis Induced Leukopenia?

Blood Pressure, Ventilation and Lipid Imbalance during Hemodialysis: Effect of Dialysate Composition

“…His findings of an increased alveolar-arterial oxygen gra dient, a decreased carbon monoxide (CO) diffusing capacity and an increased small air way resistance during hypoxemia suggested such a mechanism. Additional studies have likewise provided some evidence to support the latter conclusion [56,70,71,75,94], Moreover, the observation that hypoxemia has not been reported to occur in leukopenic individuals [59,72] can similarly be con strued as indirect evidence to support the pathogenetic role of leukocyte embolization.…”

“…63]. Leukopenia is a transient phenome non usually limited to the first 15-30 min of dialysis [63][64][65][66][67][68][69][70][71][72], It appears that the type of membrane utilized plays an important role in the development of leucopenia, since cuprophane. cellulose acetate, and regenerated cel lulose have been reported to induce leukope nia [58, 63, 65-69.…”

“…For example, it has been shown that during isolated ultrafiltration, despite com plement activation and leukopenia, hypox emia is not usually observed [47,63,64,72], Similarly, hypoxemia has been documented to occur during hemodialysis despite the fact that leukocyte counts did not change or ac tually increased [65,70]. Furthermore, hyp oxemia still occurred even when membranes which usually do not activate complement (or cause leukopenia) were utilized [63,65,70,102], Notwithstanding these facts, the development of hypoxemia during the initial 15-30 min of hemodialysis is probably caused by leukocyte aggregation and emboli zation when the membrane utilized is able to activate complement [56.…”

Complement Activation in Extracorporeal Circulation: Physiological and Pathological Implications

“…Nevertheless, even if these similarities are intriguing, it is necessary to point out that the occurrence of a severe acute lung damage during ECC is a very rare event, while complement activation is the rule. Ob servations from different authors contradict the hypothesis that HD hypoxemia is related to the pulmonary leukostasis [11,28]. A ma jor role in the genesis of hypoxemia is in fact probably played by reduction in ventilation subsequent to loss of CO?…”

Hypoxemia during Hemodialysis Using Acetate versus Bicarbonate Dialysate

“…One is a ventilation-perfusion (V/Q) abnormality caused either by microembolization to the lungs of aggre gates formed in the dialyzer [6] or from complementmediated leukostasis in pulmonary capillaries [3,4,7], The development of hypoxemia and decreased pulmo nary diffusion capacity during hemodialysis coincide in time with leukopenia. In addition, direct correlations between the fall in leukocyte count and the reduction in arterial oxygen tension and carbon monoxide diffusion capacity (DlCO) during hemodialysis supports this mechanism [7], Abnormalities in V/Q do not, however, account for hypoxemia when microembolization and leukopenia are eliminated by the use of polyester filters or reused cellu lose acetate and poly-acrylonitrile dialyzers (PAN), re spectively [6,9], Dialysis-related hypoxemia may, in stead. be due to another mechanism arising from CO2 loss across the dialyzer [1,2,4,9], This leads to alveolar hypoventilation, decreased alveolar oxygen tension (PAO2), and arterial oxygen tension (PaCri) without any concomitant change in arterial CO2 tension (PaCX^).…”