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

Abstract

Objective: To evaluate lung function and functional capacity in patients with chronic kidney failure (CKF) undergoing dialysis and in patients after kidney transplant. Methods: Seventy-two participants were evaluated: 32 patients with CKF on dialysis (DG) for at least six months, ten patients who had kidney transplants (TG) at least six months earlier, and 30 healthy subjects as a control group (CG). all groups were evaluated using spirometry, with maximum inspiratory pressure (mIP) and maximum expiratory pressure (mEP), and using the six-minute walking test (6mWT). The SPSS 12.0 software was used for statistical analysis, with a minimum significance level of α<0.05. Results: There was a decreased lung function in the DG for FVC, FEV1, mVV, VC, mIP and mEP, and decreased FEV1 and mVV in the TG compared to the CG (one-way aNOVa/Fisher's post-hoc; p<0.01). There was also an association (chi-square) between decreased mIP and belonging to the DG ‫,5.0=ג(‬ p<0.001), between lower performance in the 6mWT for the DG and TG (p<0.01) compared to the CG (one-way aNOVa/Fisher's post-hoc), and between mIP and mEP (Pearson's coefficient; r=0.752; p<0.01). Conclusions:Patients with CKF undergoing dialysis showed impaired functional capacity and lung function that were not completely reverted in the kidney transplant patients.Key words: dialysis; kidney transplant; spirometry; respiratory muscles; functional capacity. ResumoObjetivo: avaliar a função pulmonar e a capacidade funcional em pacientes com insuficiência renal crônica (IRC) em hemodiálise e em pacientes após transplante renal. Métodos: Foram avaliados 72 indivíduos, sendo 32 pacientes com IRC em hemodiálise (GD) há mais de 6 meses, 10 pacientes transplantados renais (GT) há, pelo menos, 6 meses e 30 sujeitos saudáveis para grupo controle (GC). Todos os grupos foram avaliados utilizando espirometria, pressões inspiratória (PImax) e expiratória (PEmax) máximas e teste da caminhada em seis minutos (TC6min). Para análise estatística, foi utilizado o programa SPSS 12.0, com nível mínimo de significância α<0,05. Resultados: Foram encontrados resultados estatisticamente significativos (p<0,01) para: diminuição da função pulmonar no GD para Capacidade vital forçada (CVF), Volume expirado forçado (VEF1), Ventilação voluntária máxima (VVm), Capacidade vital (CV), PImax, PEmax e, para o GT, diminuição do VEF1 e VVm, quando comparados ao GC (aNOVa uma via/post hoc Fischer); associação (qui-quadrado) entre diminuição da PImax e pertencer ao GD ‫,5,0=ג(‬ p<0,001); menor desempenho no TC6min no GD e GT (p<0,01) quando comparados ao GC (aNOVa uma via/post hoc Fischer). Encontrou-se correlação significativa (coeficiente de Pearson) entre PImax e PEmax (r=0,752, P<0,01). Conclusões: Pode-se concluir que existem alterações na capacidade funcional e na função pulmonar do paciente com IRC em hemodiálise, as quais são indicativas de prejuízos funcionais que não se apresentam completamente revertidos no paciente transplantado renal.

Effects of non-invasive ventilatory support in tolerance to the effort of patients with hemodialysis

“…Regarding their functional capacity, it was observed that values obtained in the 6WT were signi icantly lower than the predicted values for this population. Cury et al (1) observed that there is a tendency for individuals with CKD to obtain lower results in comparing the expected with the general population. Faria et al (21) noticed that only one individual from the sample, after the 6WT, presented a lower result than the expected in the walk test, and the other patients achieved the expected values.…”

“…Cury et al (1) showed that in the group of individuals undergoing dialysis, 1 individual presented a MVD and 7 were classi ied as presenting a RVD, in the group of transplanted only 1 individual presented a RVD and the sample remaining presented no alteration in the spirometry.…”

“…The Chronic Kidney Disease (CKD) is determined by the loss of glomerular, tubular and endocrine function of kidneys in a progressive and irreversible way (1,2). With its progression, kidneys become unable to maintain the normal functioning of body systems (1), requiring the treatment of renal replacement (3).…”

“…With its progression, kidneys become unable to maintain the normal functioning of body systems (1), requiring the treatment of renal replacement (3).…”

“…With its function changed by CKD, patients are more prone to systemic arterial hypertension, water retention, anemia (2) and musculoskeletal disorders (6), including the respiratory musculature (1). Patients may develop a generalized muscle weakness, affecting negatively on the tolerance to physical exercise and on the quality of life (QL) of patients (1,6).…”