Lung Dysfunction and Chronic Kidney Disease: A Complex Network of Multiple Interactions

Abstract

Chronic kidney disease (CKD) is a progressive disease that affects > 10% of the total population worldwide or >800 million people. CKD poses a particularly heavy burden in low- and middle-income countries, which are least able to cope with its consequences. It has become one of the leading causes of death worldwide and is one of the few non-communicable diseases where the number of related deaths has increased over the last two decades. The high number of people affected, and the significant negative impact of CKD should be a reason to increase efforts to improve prevention and treatment. The interaction of lung and kidney leads to highly complex and difficult clinical scenarios. CKD significantly affects the physiology of the lung by altering fluid homeostasis, acid-base balance and vascular tone. In the lung, haemodynamic disturbances lead to the development of alterations in ventilatory control, pulmonary congestion, capillary stress failure and pulmonary vascular disease. In the kidney, haemodynamic disturbances lead to sodium and water retention and the deterioration of renal function. In this article, we would like to draw attention to the importance of harmonising the definitions of clinical events in pneumology and renal medicine. We would also like to highlight the need for pulmonary function tests in routine clinical practise for the management of patients with CKD, in order to find new concepts for pathophysiological based disease-specific management strategies.

Keywords: chronic kidney disease; chronic obstructive pulmonary disease; lung dysfunction; obstructive sleep apnoea; pulmonary hypertension; renal impairment; sleep-related breathing disorders.

Figure 1

Pulmonary complications related to CKD. CKD: chronic kidney disease. RAS: renin-angiotensin System. OSA: obstructive sleep apnoea. ESRD: end-stage renal disease. IVCD: inferior vena cava diameter. CI: collapsibility index. GFR: glomerular filtration rate. HD: hemodialysis. COPD: chronic obstructive pulmonary disease. AKI: acute kidney injury. MAB: microalbuminuria.