Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease

Abstract

BackgroundCardiovascular disease (CVD), protein-energy wasting (PEW), and inflammation are common interrelated features of chronic kidney disease (CKD). Less is known about lung dysfunction in CKD and its possible role in this context. We evaluated lung function and its association with estimated glomerular filtration rate (GFR), CVD, PEW, and inflammation in individuals with normal to severely reduced GFR.MethodsIn 404 individuals with GFR category G1 (n = 31; GFR >90mL/min/1.73 m2), G2 (n = 46), G3 (n = 33), G4 (n = 49) and G5 (n = 245; GFR<15mL/min/1.73 m2), pulmonary function was assessed by spirometry. Obstructive (OLD) and restrictive (RLD) lung dysfunction was defined based on forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and peak expiratory flow (PEF), expressed as percentages of predicted values (%FEV1, %FVC and %PEF, respectively). PEW was evaluated by subjective global assessment, handgrip strength (HGS) and lean body mass index (LBMI), and inflammation by interleukin-6 and high sensitivity C-reactive protein.ResultsRLD (defined as FEV1/FVC ≥ 0.70 and %FVC<80) associated with GFR and was present in 36% of G5 and 14% of G1-4 individuals. OLD (FEV1/FVC<0.70) was less common with similar prevalence among G1-4 (9%) and G5 (11%) individuals. Notably, 64% of those with concomitant presence of PEW, inflammation and clinical signs of CVD had RLD while 79% of those lacking these complications had normal lung function. In multivariate logistic regression analysis, RLD associated with CVD, PEW and inflammation, after adjusting for Framingham’s CVD risk score, serum albumin, and GFR category.ConclusionsRLD is a common complication in patients with advanced CKD, especially in those with concomitant presence of CVD, inflammation and PEW. RLD appears to be an integral albeit scarcely explored consequence of pulmonary-renal interactions in CKD patients.

Impact of Age-related Diseases on Pulmonary Function Tests in Older Japanese Adults: A Cross-sectional Pilot Study

“…Regarding peripheral artery disease, increased brachial-ankle pulse wave velocity (>1400 cm/s) is associated with moderate-to-severe airflow limitation (16) . Restrictive lung dysfunction is a common complication in patients with ESRD (17) . A decline in VC in patients with mood disorders is reasonable as muscle strength is inversely associated with depressive symptoms (18) , (19) .…”

Respiratory Failure: A Rare Complication of Chronic Kidney Disease Mineral and Bone Disorder

“…6 A 2018 epidemiologic study found that 36% of patients with a GFR <15 mL/min/1.73 m 2 demonstrate asymptomatic restrictive indices on spirometry, presumably attributable to the various processes outlined above. 7 Importantly, most patients did not have coexisting primary lung disease. Symptomatic respiratory failure is unique and represents a severe manifestation of CKD-MBD.…”

“…Other postulated mechanisms potentially contributing to this patient's symptoms include subclinical pulmonary edema, diaphragmatic palsy, and respiratory muscle wasting due to uremia. 6,7 CONCLUSION CKD-MBD is a systemic disorder in the metabolism of bone and minerals that is common in patients with CKD. Most aspects of its evaluation and management relate to controlling biochemical changes, as CKD-MBD is generally asymptomatic for many years.…”

Low lung function and the risk of incident chronic kidney disease in the Malmö Preventive Project cohort

“…Although there has been some cross-sectional research assessing the relationship between low lung function and CKD [25][26][27][28][29], we are aware of few studies assessing the role of lung function in the prediction of incident kidney disease [30,31], which have found low lung function to be independently associated with CKD progression.…”