Função pulmonar e força muscular respiratória em pacientes com doença renal crônica submetidos à hemodiálise

Abstract

Objective: To evaluate pulmonary function and respiratory muscle strength in chronic renal failure patients, correlating these variables with hemodialysis-related weight fluctuation; to study the correlation between the duration of hemodialysis and potential respiratory alterations. Methods: Seventeen patients (median age, 47 years; interquartile range, 41-52 years), submitted to three weekly hemodialysis sessions for a median of 27 months (interquartile range, 14-55) were evaluated. Twelve of the patients were male. The patients underwent spirometry. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured prior to and after the first hemodialysis session of the week. Body weight was quantified prior to and after each of the three weekly sessions. Results: Before the first hemodialysis session of the week, 8 patients presented mild restrictive defect, which normalized after the session in 2 of those patients. After dialysis, there was a significant increase in forced vital capacity (p = 0.02) and a significant decrease in body weight (p = 0.0001). Weight fluctuation over 3 days without hemodialysis tended to correlate with the variation in forced vital capacity in the first weekly session (r = 0.47; p = 0.055). Duration of hemodialysis correlated with predialysis MIP (r = −0.3; p = 0.03) and MEP (r = −0.63; p = 0.006). Conclusions: More pronounced weight gain in the interdialytic period is associated with worsening of lung function, which is almost fully reversible by hemodialysis. In addition, longer duration of hemodialysis is associated with decreased respiratory muscle strength.Keywords: Spirometry; Respiratory muscles/physiopathology; Kidney failure, chronic; Renal dialysis. ResumoObjetivo: Avaliar a função pulmonar e a força muscular respiratória de pacientes com doença renal crônica e correlacioná-las com a variação de peso ligada à realização de hemodiálise; estudar a correlação entre o tempo de hemodiálise e possíveis alterações respiratórias. Métodos: Foram avaliados 17 pacientes (mediana de idade, 47 anos; intervalo interquartílico, 41-52 anos) submetidos a três sessões semanais de hemodiálise (mediana de tempo, 27 meses; intervalo interquartílico, 14-55). Doze eram do sexo masculino. Realizaram espirometria e mensuração das pressões máximas inspiratória (PImáx) e expiratória (PEmáx) antes e após a primeira sessão semanal de hemodiálise. O peso corporal foi quantificado antes e após as três sessões semanais. Resultados: Oito pacientes apresentaram distúrbio restritivo leve antes da primeira sessão de hemodiálise. Desses, 2 normalizaram após a sessão. Houve aumento da capacidade vital forçada (p = 0,02) e diminuição de peso (p = 0,0001) ao final da primeira sessão semanal. A variação de peso durante três dias sem hemodiálise tendeu a se correlacionar com a variação da capacidade vital forçada na primeira sessão (r = 0,47; p = 0,055). O tempo de hemodiálise correlacionou-se com os valores da porcentagem do predito da PImáx (r = −0,53; p = 0,03) e com a PEmáx (r = −...

Prevalence of nursing diagnosis of fluid volume excess in patients undergoing hemodialysis

“…A study reported that abnormal findings, such as congestion in the pulmonary tree of such patients are frequently a result of bodily fluid overload in the interdialytic period, and greater weight gain during this period is associated with worsening of lung function (11) . Thus, the interdialytic weight gain appears to be an important variable to be considered in these patients, since their daily abrupt variation is related to the accumulation of liquids and hardly related to increased body mass (28) .…”

“…The latter is the main risk factor for developing coronary artery disease, cerebrovascular disease and pulmonary congestion (2,(4)(5)11) .…”

Efeitos negativos da insuficiência renal crônica sobre a função pulmonar e a capacidade funcional

“…All tests were performed by a trained evaluator. For DG, the evaluations were conducted on the second and third day of dialysis in the week (Wednesday and Friday or Thursday and Saturday) 21 .…”

Repercussão de um protocolo fisioterapêutico intradialítico na funcionalidade pulmonar, força de preensão manual e qualidade de vida de pacientes renais crônicos

“…3,6,12,14 The most commonly found pulmonary alterations are as follows: limitation to air flow; obstructive disorders; a reduction in pulmonary diffusion capacity; and a decrease in respiratory muscle endurance and strength. 3,6,14 However, measuring respiratory muscle strength and function allows the early diagnosis of those changes, helping in establishing supervised training protocols.…”

“…A new and challenging area for physical therapy is the physical and functional rehabilitation of patients with chronic kidney disease (CKD).¹ Chronic kidney disease can be defined, according to the Brazilian Society of Nephrology,² as the slow, progressive, and irreversible loss of renal function, a condition in which the kidneys have no functionality as a consequence of damage to the nephrons, [1][2][3] resulting in incapacity of the organism to maintain renal metabolic and hydroelectrolytic balance. [4][5] Renal dysfunction is characterized by a glomerular filtration rate (GFR) lower than 60 mL/ min/1.73m 2 , for more than three months, and, when GFR reaches levels lower than 15 mL/min/1.73m 2 , the renal dysfunction is called end-stage CKD.…”