Diaphragmatic dysfunction associates with dyspnoea, fatigue, and hiccup in haemodialysis patients: a cross-sectional study

Abstract

Muscle wasting is associated with increased mortality and morbidity in chronic kidney disease (CKD) patients, especially in the haemodialysis (HD) population. Nevertheless, little is known regarding diaphragm dysfunction in HD patients. We conducted a cross-sectional study at the Institute of Nephrology, Southeast University, involving 103 HD patients and 103 healthy volunteers as normal control. Ultrasonography was used to evaluate diaphragmatic function, including diaphragm thickness and excursion during quiet and deep breathing. HD patients showed lower end-inspiration thickness of the diaphragm at total lung capacity (0.386 ± 0.144 cm vs. 0.439 ± 0.134 cm, p < 0.01) and thickening fraction (TF) (0.838 ± 0.618 vs. 1.127 ± 0.757; p < 0.01) compared to controls. The velocity and excursion of the diaphragm were significantly lower in the HD patients during deep breathing (3.686 ± 1.567 cm/s vs. 4.410 ± 1.720 cm/s, p < 0.01; 5.290 ± 2.048 cm vs. 7.232 ± 2.365 cm; p < 0.05). Changes in diaphragm displacement from quiet breathing to deep breathing (△m) were lower in HD patients than in controls (2.608 ± 1.630 vs. 4.628 ± 2.110 cm; p < 0.01). After multivariate adjustment, diaphragmatic excursion during deep breathing was associated with haemoglobin level (regression coefficient = 0.022; p < 0.01). We also found that the incidence of dyspnoea and hiccup and the fatigue scores, all of which were related to diaphragmatic dysfunction, were significantly higher in HD patients than in controls (all p < 0.01). Improving diaphragm function through targeted therapies may positively impact clinical outcomes in HD patients.

Effect of respiratory muscle training in patients with chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials

“…It is well known that the diaphragm is an essential tissue for respiratory muscle strength. 35 It was found that the diaphragm in chronic kidney disease patients experiences pathological changes in response to abnormal renal function, such as shortened myogenic fibers and increased oxygen uptake capacity, 36 and these changes explain the fact that chronic kidney disease patients can produce comparable or higher muscle tension than healthy controls, causing dyspnea. In addition, hemodialysis maintenance therapy promotes a progressive loss of inspiratory muscle strength that worsens further with the duration of dialysis treatment.…”

Ultrasound-assessed diaphragm dysfunction predicts clinical outcomes in hemodialysis patients

“…The study was conducted at the Institute of Nephrology, Southeast University, an academic medical HD center in Nanjing, Jiangsu, China. This cohort came from a previous study conducted by our team and the detail of these patients have been published 23 . A total of 103 maintenance HD patients, aged 24 to 81 years old, were recruited from May 2018 to November 2018.…”

“…Ultrasound-assessed diaphragm dysfunction is reliable in early identifying diaphragm atrophy and stratifying patients’ risk of worse prognosis 18 – 22 . Our research group has previously reported that the ultrasound-assessed diaphragm function of HD patients is worse than that of healthy individuals, and is associated with dyspnea, fatigue and hiccup in HD patients 23 .…”

Effect of Different Types of Deep Breathing Training on Functional Capacity and Fatigue Level in Hemodialysis Patients

“…However, little is understood about diaphragm dysfunction in HD patients. The high incidence of dyspnea and the fatigue scores in HD patients were related to diaphragmatic dysfunction (3) .…”