Abstract:The density of the lung reflects the total mass of fluid, air, and dry lung tissue per unit volume of the lung. Lung density can be measured by evaluation of attenuation of an electron beam with computed tomography (CT). This technique has been shown to be sufficiently reliable and sensitive to distinguish normal from abnormal lung water. The aim of this study was to find out whether lung density properly reflects the hydration status in hemodialysis patients in comparison with other standard methods. Fourteen… Show more
“…A number of new techniques have been introduced to determine the ideal or "true" postdialytic dry weight of dialysis patients. These include, among others, lung density assessment using dual X-ray and computerized tomographic densitometry [21,22], echography of the caval vein [4,23], continuous optical hemoglobin monitoring [24], conventional and vector analysis of bioimpedance [25], and the measurement of the basal thoracic impedance [21]. Continuous cardiovascular monitoring during dialytic fluid withdrawal is essential for better understanding and control of the adaptation process.…”
Hemodialysis (HD) causes rapid volume shifts and circulatory changes. In chronic renal failure (CRF) Na+/K+ATP-ase is depressed, whereas endogenous digoxin-like factor (EDLF) is elevated. Our aim was to characterize HD-induced cardiovascular adaptation and its possible links to Na+/K+ATP-ase and EDLF. Eleven children with CRF on HD (aged 14.7 +/- 3.7 years) and 11 healthy children were investigated for basic circulatory parameters. Thoracic impedance (Zo) and circulatory parameters were monitored by impedance cardiography (ICG) during HD. Erythrocyte Na+/K+ATP-ase and EDLF were measured before and after HD. Up to the loss of 6% of total body weight, Zo rose linearly with fluid removal, above this no further increase occurred. Heart rate and mean arterial pressure (MAP) were inversely related (r = -0.97); MAP rose in the first and decreased in the second part of HD. Systemic vascular resistance paralleled MAP, whereas stroke volume rapidly decreased, but stabilized in the second part of HD. The ratio of preejection period/ventricular ejection time (PEP/VET) correlated positively with HD duration (r = 0.92), suggesting diminished cardiac filling. Cardiac index (CI) remained stable. EDLF was high in uremia accompanied by depressed Na+/K+ATP-ase (P < 0.05 and P < 0.01, respectively). Following HD Na+/K+ATP-ase normalized. Correlation between Na+/K+ATP-ase activity and MAP was linear (r = 0.85). In conclusion, ICG during HD provides detailed information concerning circulatory adaptation resulting in stable CI, suggesting that the dialysis-induced hypovolemia is compensated by the centralization of the blood volume. Changes of Na+/K+ATP-ase indicate that dialyzable blood pressure-regulating substance(s) inhibit(s) the pump. However, lack of further correlation between Na+/K+ATP-ase, EDLF, and cardiovascular parameters indicates the complexity of the regulatory processes.
“…A number of new techniques have been introduced to determine the ideal or "true" postdialytic dry weight of dialysis patients. These include, among others, lung density assessment using dual X-ray and computerized tomographic densitometry [21,22], echography of the caval vein [4,23], continuous optical hemoglobin monitoring [24], conventional and vector analysis of bioimpedance [25], and the measurement of the basal thoracic impedance [21]. Continuous cardiovascular monitoring during dialytic fluid withdrawal is essential for better understanding and control of the adaptation process.…”
Hemodialysis (HD) causes rapid volume shifts and circulatory changes. In chronic renal failure (CRF) Na+/K+ATP-ase is depressed, whereas endogenous digoxin-like factor (EDLF) is elevated. Our aim was to characterize HD-induced cardiovascular adaptation and its possible links to Na+/K+ATP-ase and EDLF. Eleven children with CRF on HD (aged 14.7 +/- 3.7 years) and 11 healthy children were investigated for basic circulatory parameters. Thoracic impedance (Zo) and circulatory parameters were monitored by impedance cardiography (ICG) during HD. Erythrocyte Na+/K+ATP-ase and EDLF were measured before and after HD. Up to the loss of 6% of total body weight, Zo rose linearly with fluid removal, above this no further increase occurred. Heart rate and mean arterial pressure (MAP) were inversely related (r = -0.97); MAP rose in the first and decreased in the second part of HD. Systemic vascular resistance paralleled MAP, whereas stroke volume rapidly decreased, but stabilized in the second part of HD. The ratio of preejection period/ventricular ejection time (PEP/VET) correlated positively with HD duration (r = 0.92), suggesting diminished cardiac filling. Cardiac index (CI) remained stable. EDLF was high in uremia accompanied by depressed Na+/K+ATP-ase (P < 0.05 and P < 0.01, respectively). Following HD Na+/K+ATP-ase normalized. Correlation between Na+/K+ATP-ase activity and MAP was linear (r = 0.85). In conclusion, ICG during HD provides detailed information concerning circulatory adaptation resulting in stable CI, suggesting that the dialysis-induced hypovolemia is compensated by the centralization of the blood volume. Changes of Na+/K+ATP-ase indicate that dialyzable blood pressure-regulating substance(s) inhibit(s) the pump. However, lack of further correlation between Na+/K+ATP-ase, EDLF, and cardiovascular parameters indicates the complexity of the regulatory processes.
“…Patients with CRF, even in the absence of cardiopulmonary symptoms, accumulate interstitial pulmonary fluid, which is removed by haemodialysis [26,27]. Thus, in the study of Wallin et al, despite normal gas exchange, central blood volume and cardiac output at the start of dialysis, extravascular lung water before HD was found increased by 33% compared to controls, while after HD there was an almost 20% decrease.…”
Section: Table 1 Mechanisms Proposed For Dialysis-induced Hypoxemiamentioning
confidence: 93%
“…Increased lung density before dialysis was also demonstrated with CT densitometry. Lung density reflected changes in intravascular volume and significant reductions or even normalization of lung density could be seen after dialysis [27,28]. Decreases in lung density were paralleled by improvement in lung volumes [28].…”
Section: Lung Function In Patients With Chronic Renal Failurementioning
Chronic renal failure may be associated with a wide spectrum of respiratory disorders, varying from relatively minor derangements in pulmonary function testing, to frank pulmonary edema. Although complications like uremic lung are becoming increasingly rare in these patients with timely initiation of dialysis, dialysis itself can also exert a transient deleterious influence on gas exchange. Moreover, patients with chronic renal failure often exhibit disorders of the chemical control of breathing that probably contribute to sleep-disordered breathing. Sleep -disordered breathing is a common problem in patients with chronic renal failure, with a reported prevalence possibly exceeding 70% for end-stage renal disease. Sleep disorders, have a serious impact in the quality of life in chronic renal failure, and are probably associated with increased morbidity and mortality. The role of polysomnography and of active intervention in sleep disorders in these patients needs to be further elucidated.
“…Thin-section Computed tomography (CT) can visualize vessels with up to 300µm small diameter, and the background density of lung parenchyma represents vascular density with smaller diameter than 300µm. However, the background density can be easily affected by volume of air, interstitial thickness, and body fluid [1][2][3][4][5][6][7] . Microfocal angiography is an accurate method for evaluation of regional blood flow, but not applicable in clinical practice [8][9] .…”
The common and important change of pulmonary hemodynamics is represented by increased or decreased pulmonary blood flow (PBF) and increased pulmonary vascular resistance (PVR). We made 3 hemodynamic models in 5 dogs, that is, increased and decreased PBF model and increased PVR model. CT perfusion scan was performed.Perfusion parameters including blood flow (BF), blood volume (BV), mean transit time (MTT), and maximal slope (MS) were analyzed. In normal state, blood flow was affected by gravity and dependent area showed higher BF, BV and lower MS, MTT than non-dependent area. First, decreased PBF model showed no significant change in BV and elongation of MTT. Secondly, increased PBF model showed slightly increased BV and decreased MTT. Thirdly, increased PVR model showed significant decrease of BF, BV, and MS and slight increase of MTT without statistical significance. However, it was noticeable that the distribution of MTT according to gravity in normal lung was completely reversed in increased PVR model. In conclusion, on the basis of our understanding of perfusion characteristic in normal state, we can detect and evaluate the abnormal regional hemodynamic change in lung.Predicting the change of pulmonary vascular resistance should be possible by thorough analysis of CT perfusion parameters.
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