Uremia

PURPOSE: In patients with chronic renal failure (CRF) there are increased systemic complications induced by the kidney disorders. Every system in the body can be affected, including the lung. Pulmonary oedema and pleural effusions are relatively common. Rarer complications include pulmonary fibrosis and calcification, pulmonary hypertension, haemosiderosis, pleuritis and pleural fibrosis. Renal replacement therapy my also result in complications. Haemodialysis causes recurrent episodes of hypoxaemia due to partial blockage of the pulmonary capillary bed by white cells or silicone microemboli. We estimate effect of different forms of renal replacement therapy (peritoneal dialysis and haemodialysis) on ventilator function improvement in patients with CRF [1, 2].

METHODS: We studied 43 patients (males, females) with CRF who were clinically and radiologically free from known chronic lung and chest wall disease. Twenty one patients (group 1) were receiving continuous ambulatory peritoneal dialysis (CAPD); we studied these patients with the abdomen containing dialysate. Twenty two patients (group 2) were being treated with regular haemodialysis. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory flow of vital capacity (FEF25, 50, 75) were recorded. The results were analyzed using Student t-test, and presented as mean [+ or -] SD. All p values < 0,05 were considered significant.

RESULTS: The values of ventilatory function (FEF25) were significantly lower in patients having continuous ambulatory peritoneal dialysis (table 1).

CONCLUSION: The values of ventilatory function (FEF25) were significantly lower in patients having continuous ambulatory peritoneal dialysis.

CLINICAL IMPLICATIONS: Preliminary observations suggest reversibility of airway obstruction with salbutamol.

References:

[1.] Prezant DJ. Effect of Uremia and its Treatment on Pulmonary Function. Lung 1990; 168: 1-14.

[2.] Meyer FJ et all. Peripheral airway opstruction in pimary pulmonary hypertension. Thorax 2002; 57: 473-476.

DISCLOSURE: Amela Matavulj, None.

Amela E. Matavulj MD * Pedja Kovacevic MD Slavimir Veljkovic MD Zvezdana Rajkovaca MD Mirjana Djekic-Cadjo MD Nenad Ponorac MD Medical school, Department of Physiology, Banjaluka, Bosnia-Herzegovina

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group