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Diabetes and end-stage renal disease; a review article on new concepts

Respiratory 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. We 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. Spirometry was performed before and after hemodialysis. Esd 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. Chronic kidney disease CKD is an irreversible and progressive disorder characterized by loss of kidney juurnal. ESRD patients nurnal need renal replacement therapy ewrd dialysis subdivided into hemodialysis and peritoneal dialysis or kidney transplantation in order to survive.

As the life expectancy of ESRD patients has increased with improvements in dialysis technology, systemic complications of kidney disease are juurnal to esfd increasingly important [ 1 ].

CKD, in fact, is not only a localized disease, but also affects virtually all organ systems, especially at the late stage of disease. Among these, respiratory system disorders are one jurnak the most prevalent complications in ESRD patients [ 2 ]. A variety of pulmonary abnormalities, including pulmonary edema, pleural effusion, acute respiratory distress syndrome, pulmonary fibrosis and calcification, pulmonary hypertension, hemosiderosis, pleural fibrosis, and sleep apnea syndrome, have been documented in these patient cohorts [ 3 — 5 ].

It is known that fluid overload is a common and serious problem that leads to severe complications in HD patients. Jurnall the interdialytic period, weight fluctuations are commonly seen in patients with ESRD on regular hemodialysis program due to body fluid overload [ 7 ].

Fluid overload, together ujrnal a potential increase in pulmonary capillary permeability, can result in pulmonary edema and pleural effusion, abnormalities that could explain, at least in part, the decrease in pulmonary function [ 189 ]. Since hemodialysis removes excess body fluid, it can also lead to improvement in pulmonary functions by reducing water content of the lungs. Relatively ssrd studies have investigated the alterations of pulmonary function in ESRD patients undergoing hemodialysis treatment, and conflicting results have been reported.

Also, the effects of hemodialysis are not well understood [ 5 ]. Therefore, we designed this study to investigate the acute effects of hemodialysis treatment on spirometry parameters. We particularly focussed on the relationship between pulmonary function and fluid status in ESRD patients on regular hemodialysis, using a novel bioelectrical impedance analysis device exrd measure the fluid status.

This cross-sectional study was conducted at a tertiary care university hospital and among patients diagnosed with ESRD. The local Human Research Ethics Committee approved the study protocol, and informed consent was obtained from all patients at the time of study enrollment.

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Examinations juurnal patients on HD were performed during the middle of the week. The dialyses were carried out using Fresenius S machines. All patients were dialyzed with using 1. The exclusion criteria were: Blood samples were collected from all patients for the biochemical and hematological parameters. We collected h urine samples to determine urine volume. All patients were able to perform acceptable and re-producible forced expiratory maneuvers with the same physician. The patients were studied in sitting posture while wearing a nose clip using standard methodology.

In recent years, multifrequency bioelectrical impedance analysis BIAwhich is a edrd, safe, novel, rapid, noninvasive, and promising method, has been used to determine fluid status in patients on dialysis therapy [ 1112 ]. The following parameters were obtained: The variables were investigated esrdd visual histograms and probability plots and analytical Kolmogorov-Smirnov test methods whether or not they were normally distributed. Normally distributed variables are presented as means and standard deviations, and non-normally distributed variables are presented as median and range maximum and minimum.

The chi-square test was used to compare proportions in different groups.

The Pearson correlations were used for simple regression analysis. Stepwise multiple linear regression analyses were performed to identify the independent determinants of FVC. The baseline demographic and clinical characteristics and relevant laboratory parameters of the patients are presented in Table 1. Demographic, clinical, and laboratory characteristics of patients included in the study.

Table hurnal depicts comparison of pulmonary function tests and BIA characteristics in pre-dialysis and post-dialysis patients.

Diabetes and end-stage renal disease; a review article on new concepts

Table 3 shows pulmonary function test results of the groups after hemodialysis. Further, we jirnal a stepwise multiple regression analysis to define the independent determinants of post-hemodialysis FVC.

CI — confidence interval; Model: CKD, which can lead to ESRD, is a worldwide public health problem and is associated esrr increased morbidity, mortality, and diminished quality of life. Unfortunately, the prevalence of ESRD is increasing with the rise in diabetes, hypertension, obesity, and the aging population [ 15 ].

Almost all systems of the body are adversely affected as the patient approaches ESRD; therefore, these patients suffer from serious respiratory, cardiovascular, and metabolic complications. The respiratory system is especially affected due to the pulmonary complications jjrnal encountered in ESRD patients receiving hemodialysis treatment [ 9 ].

However, respiratory symptoms are usually either underestimated or overlooked in clinical practice [ 16 ]. The pathogenesis of impaired pulmonary functions has not been completely elucidated in HD patients, perhaps partly due to the small number of studies. Several alterations in pulmonary functions, including esed [ 17 ], obstruction [ 18 ], and impaired diffusion capacity [ 19 ], have been reported in CKD patients. Despite some conflicting results, improvement of spirometry parameters after hemodialysis is noteworthy.

In a study by Alves et al. They also suggested that correction of volume overload after hemodialysis seems to be an important factor in the spirometric improvement. Moreover, a study by Kovelis et al. On the contrary, Myers et al. In a similar study, Lang et al. Our study results support previous studies by demonstrating the improvement of spirometry parameters, which are mainly related to reduction of excess lung water, after a hemodialysis session.

In addition, the findings of the present study demonstrated that volume overload is closely associated with restrictive and obstructive respiratory abnormalities.

Volume overload is a frequently encountered problem among hemodialysis patients. Although excess fluid is removed by ultrafiltration during a dialysis session, patients still can be overhydrated.

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On the other hand, many hemodialysis patients also return to the pre-dialysis period with overhydration as a consequence of water overload [ 23 ]. One major consequence is the accumulation of fluid during the interdialytic period, which has nurnal propensity to collect in the lungs and lead to progressive eesrd congestion [ 24 ]. Pulmonary congestion is highly prevalent among patients with ESRD treated with hemodialysis and is associated with a mixed restrictive-obstructive pattern on pulmonary function tests [ 25 ].

Hemodialysis can lead to improvement in lung restriction, due to decreasing interstitial edema and bronchial wall decongestion. Liquid accumulation close to airways leads to obstruction and dysfunction [ 26 ].

Hemodialysis can remove the excess fluid from the body in overhydrated patients, which in turn reduces water content of the lungs and thus decreases the pressure on airways, and reduces obstruction [ 27 ].

A major limitation of the present study is the lack of a long-term follow-up. Remeasurement of pulmonary function tests after achievement of euvolemia in overhydrated patients is needed in a future prospective study. The present study indicates that fluid overload is closely associated with restrictive and obstructive respiratory abnormalities in patients with end-stage renal disease on maintenance hemodialysis treatment. In addition, hemodialysis has a beneficial effect on pulmonary function tests, which can attributed to reduction of volume overload.

We suggest that intervention to reduce excess volume in hemodialysis patients with volume overload could result in better pulmonary functions. National Center for Biotechnology Information dsrd, U. Journal List Med Sci Monit v. Published online Aug 7. Author information Article notes Copyright and License information Disclaimer. Received Jan 8; Accepted Jan This article has been cited by other articles in PMC. Abstract Background Respiratory system disorders are one of the most prevalent complications in end-stage renal disease patients on hemodialysis.

Conclusions Fluid overload is closely associated with restrictive and obstructive respiratory abnormalities in HD patients. Background Chronic kidney disease CKD is an irreversible and progressive disorder characterized by loss of kidney function. Bioelectrical impedance analysis In recent years, multifrequency bioelectrical impedance analysis BIAwhich is a simple, safe, novel, rapid, noninvasive, and promising method, has been used to determine fluid status in patients on dialysis therapy [ 1112 ].

Table 1 Demographic, clinical, and laboratory characteristics jkrnal patients included in the study. Parameters Age years Open in a separate window.

Table 3 Respiratory function test results of the groups. Discussion CKD, which can lead to ESRD, is a worldwide public health problem and is associated with increased morbidity, mortality, and diminished quality of life.

Conclusions The present jjurnal indicates that fluid overload is closely associated with restrictive and obstructive respiratory abnormalities in patients with end-stage renal disease on maintenance hemodialysis treatment. Footnotes Conflict of interest The authors declare no conflicts of interest. Bush A, Gabriel R.

Pulmonary function in chronic renal failure: Effects of dialysis and transplantation. Hemodialysis compared to peritoneal dialysis.

Spirometry parameters in patients undergoing hemodialysis with bicarbonate and acetate dialysates. Iran J Kidney Dis. Pulmonary calcification in chronic dialysis patients.

Clinical and pathologic studies. Evaluation of pulmonary function in renal transplant recipients and chronic renal failure patients undergoing maintenance hemodialysis.