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. 2014:2014:212751.
doi: 10.1155/2014/212751. Epub 2014 May 8.

Impact of hemodialysis on dyspnea and lung function in end stage kidney disease patients

Anastasios F Palamidas  1 , Sofia-Antiopi Gennimata  1 , Foteini Karakontaki  1 , Georgios Kaltsakas  1 , Ioannis Papantoniou  2 , Antonia Koutsoukou  1 , Joseph Milic-Emili  3 , Demetrios V Vlahakos  4 , Nikolaos G Koulouris  1
Affiliations

Impact of hemodialysis on dyspnea and lung function in end stage kidney disease patients

Anastasios F Palamidas et al. Biomed Res Int. 2014.

Abstract

Background: Respiratory symptoms are usually underestimated in patients with chronic kidney disease undergoing maintenance hemodialysis. Therefore, we set out to investigate the prevalence of patients chronic dyspnea and the relationship of the symptom to lung function indices.

Methods: Twenty-five clinically stable hemodialysis patients were included. The mMRC dyspnea scale was applied before and after hemodialysis. Spirometry, single breath nitrogen test, arterial blood gases, static maximum inspiratory (P(imax)) and expiratory (P(emax)) muscle pressures, and mouth occlusion pressure (P 0.1) were also measured.

Results: Despite normal spirometry, all patients (100%) reported mild to moderate degree of chronic dyspnea pre which was reduced after hemodialysis. The sole predictor of (Δ) mMRC was the (Δ) P 0.1 (r = 0.71, P < 0.001). The P(imax) was reduced before and correlated with the duration of hemodialysis (r = 0.614, P < 0.001), whilst after the session it was significantly increased (P < 0.001). Finally (Δ) weight was correlated with the (Δ) P(imax) %pred (r = 0.533, P = 0,006) and with the (Δ) CV (%pred) (r = 0.65, P < 0.001).

Conclusion: We conclude that dyspnea is the major symptom among the CKD patients that improves after hemodialysis. The neuromechanical dissociation observed probably is one of the major pathophysiologic mechanisms of dyspnea.

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Figures

Figure 1
Figure 1
(a) mMRC, (b) P 0.1—ventilatory drive, and (c) P imax⁡ before and after hemodialysis are shown. Black dots represent the individual patients and red lines represent the mean values before and after hemodialysis.
Figure 2
Figure 2
(a) Relationship of the P imax⁡ with the duration of hemodialysis for the 25 patients before and after hemodialysis (r = 0.614, P < 0.001 and r = 0.766, P < 0.001, resp.). Black dots: P imax⁡ before hemodialysis. White dots: P imax⁡ after hemodialysis. (b) Relationship of the P emax⁡ with the duration of hemodialysis for the 25 patients before and after hemodialysis (r = 0.489, P = 0.013 and r = 0.701, P < 0.001, resp.). Black dots: P emax⁡ before hemodialysis. White dots: P emax⁡ after hemodialysis.
Figure 3
Figure 3
Box plot showing the relationship of (Δ) mMRC with (Δ) P 0.1 before and after hemodialysis. Dashed line: regression line. Solid lines: median lines of the change (Δ) of P 0.1 at ΔmMRC values of 1 and 2, respectively. Regression equation: y = −0.736 + (0.905∗x) ± 2(0.44), n = 25, r = 0.71, and P < 0.001. The slope of the line indicates that the (Δ) mMRC decreases, on average, by one unit per 0.9 units decrease of the (Δ) P 0.1.
Figure 4
Figure 4
(a) Relationship of (Δ) Wt with the (Δ) CV % pred. Solid line: regression line. Regression equation: y = 1.874 − 0.0145∗x ± 2(0.195) ,   n = 23, r = 0.65, P < 0.001. Subjects, represented as black dots, are 23 because closing volume could not be calculated in 2 patients. (b) Relationship of the (Δ) Wt to (Δ) P imax⁡ % pred. Solid line: regression line. Regression equation: y = 4.064 − (0.0424∗x) ± 2(0.581), n = 25, r = 0.533, and P = 0.006. The 25 subjects are represented as black dots.
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