Renal transplantation
Pre-transplant candidate
Pulmonary Function in Renal Transplant Recipients and End-Stage Renal Disease Patients Undergoing Maintenance Dialysis

https://doi.org/10.1016/j.transproceed.2005.12.068Get rights and content

Abstract

The aim of this study was to reveal the pulmonary function status of renal transplant recipients and chronic renal failure patients on hemodialysis or continuous ambulatory peritoneal dialysis. The study involved 73 subjects, including 49 patients who were either on peritoneal dialysis (n = 22) or hemodialyis (n = 27), and 24 renal transplant recipients. The spirometry results revealed significantly higher residual volume and total lung capacity in the hemodialysis and peritoneal dialysis groups than in the transplantation group. Forced expiratory flow between 25% and 75% of vital capacity was slightly below normal in the dialysis patients. Preservation of diffusion capacity of the lung for carbon monoxide was noted in the hemodialysis group (112.4%). Inspiratory and expiratory muscle strength was reduced in all groups. Only type of dialysis was correlated with this reduction. Inspiratory muscle strength in the peritoneal dialysis group (49.9%) was significantly lower than in the transplantation and hemodialysis groups (54.7% and 66.5%, respectively). The spirometry findings suggest that small-airway disease causes increased residual volume and total lung capacity (hyperinflation) in hemodialysis and peritoneal dialysis patients and that this airway obstruction subsides after renal transplantation. Preserved diffusion capacity in the hemodialysis group was attributed to the use of biocompatible dialyzer membranes. Renal failure complications may be the main explanation for global respiratory muscle weakness in dialysis patients, whereas corticosteroid therapy might be the primary cause in kidney graft recipients. Significantly lower inspiratory muscle strength in the peritoneal dialysis group suggests that presence of intra-abdominal dialysate might interfere with diaphragmatic contraction.

Section snippets

Methods

The study involved 73 subjects, including 49 CRF patients who were either on CAPD (n = 22) or HD (n = 27) treatment, and a group of renal transplant (RT) recipients (n = 24) being followed by Baskent University Hospital, Ankara, Turkey. All were being regularly assessed in our institution’s Transplantation Department. The exclusion criteria were chronic disease of the lung or chest wall, current or previous smoking habit, and signs of hypervolemia. All patients were ambulatory and in stable

Results

Table 1 shows the demographic data for the three study groups. There were no significant differences among the groups with respect to age, sex, and etiology for CRF distribution. The mean duration of dialysis was significantly longer in the HD group than in the CAPD group. The mean time since transplantation in the RT group was 46.0 ± 41.6 months (range, 3 to 174 months).

The 24 patients in the RT group were on immunosuppressive protocols that included at least two drugs. All were using

Discussion

This investigation assessed pulmonary function in RT patients and patients on CAPD and HD. Comparison revealed that the HD group had the highest frequency of radiological pathology on chest X-ray (92.5%). Although this rate was highest in the HD group, patients in the CAPD group also had high frequencies of radiological findings and PFT interpretations (restrictive-type disorders) consistent with pulmonary venous congestion. The relatively high proportion of HD patients with hyponatremia (8/27

References (16)

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