Respiratory Muscle Weakness in Uremic Patients under Continuous Ambulatory Peritoneal Dialysis

Gómez-Fernández, Pablo; Agudo, L. Sánchez; Calatrava, J M; Escuín, Fernando; Selgas, Rafael; Martinez, Milagros; Montero, A.; Sánchez-Sicilia, L.

doi:10.1159/000183157

Cited by 45 publications

(28 citation statements)

References 5 publications

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“…Most of the patients had their catheter removed and dialysis method changed, because no success was obtained with the treatment. The main mechanical complication was early leakage (10%), which is in agreement with other studies (6,9,11,29).…”

Section: Discussionsupporting

confidence: 92%

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High-Volume Peritoneal Dialysis in Acute Kidney Injury

Ponce

Berbel

Góes

et al. 2012

Clinical Journal of the American Society of Nephrology

110

109

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Summary Background and objectives Peritoneal dialysis is still used for AKI in developing countries despite concerns about its limitations. The objective of this study was to explore the role of high-volume peritoneal dialysis in AKI patients in relation to metabolic and fluid control, outcome, and risk factors associated with death. Design, setting, participants, & measurements A prospective study was performed on 204 AKI patients who were assigned to high-volume peritoneal dialysis (prescribed Kt/V=0.60/session) by flexible catheter and cycler; 150 patients (80.2%) were included in the final analysis. Results Mean age was 63.8±15.8 years, 70% of patients were in the intensive care unit, and sepsis was the main etiology of AKI (54.7%). BUN and creatinine levels stabilized after four sessions at around 50 and 4 mg/dl, respectively. Fluid removal and nitrogen balance increased progressively and stabilized around 1200 ml and −1 g/d after four sessions, respectively. Weekly delivered Kt/V was 3.5±0.68. Regarding AKI outcome, 23% of patients presented renal function recovery, 6.6% of patients remained on dialysis after 30 days, and 57.3% of patients died. Age and sepsis were identified as risk factors for death. In urine output, increase of 1 g in nitrogen balance and increase of 500 ml in ultrafiltration after three sessions were identified as protective factors. Conclusions High-volume peritoneal dialysis is effective for a selected AKI patient group, allowing adequate metabolic and fluid control. Age, sepsis, and urine output as well as nitrogen balance and ultrafiltration after three high-volume peritoneal dialysis sessions were associated significantly with death.

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Section: Discussionsupporting

confidence: 92%

“…The works by Phu et al (25) and Bazari (27) reported that intermittent PD failed to control academia, because PD impairs diaphragm mobilization, with a resulting increase in intra-abdominal pressure and reduction in pulmonary compliance and ventilation. It also causes tissue and organ hypoperfusion and maintains acidosis (29).…”

Section: Discussionmentioning

confidence: 99%

High-Volume Peritoneal Dialysis in Acute Kidney Injury

Ponce

Berbel

Góes

et al. 2012

Clinical Journal of the American Society of Nephrology

110

109

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“…Gómez-Fernández et al 36 were among the first authors to report on evaluations of maximal respiratory pressures in this population. They evaluated CKF patients who underwent CAPD and found decreased MIP in patients with CKF (59.6% of predicted values), compared with controls (82.7% of predicted values).…”

Section: Discussionmentioning

confidence: 99%

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

Cury¹,

Brunetto²,

Aydos

2010

Rev. bras. fisioter.

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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.

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“…26 The cause is unknown, but has been related to carnitine deficiency 25 , vitamin D deficiency 27 , excessive amount of parathyroid hormone 28 , aluminum toxicity 29 , and other uremic toxins. 30,31 Uremia causes atrophy of type II muscle fibers 29 and alterations in myofibrillar ATPase, with an important reduction in energy use by the muscle, in creatine phosphorylation, and its contractility.…”

Section: Discussionmentioning

confidence: 99%

Avaliação das pressões respiratórias máximas em pacientes renais crônicos nos momentos pré e pós-hemodiálise

Rocha

Araújo

2010

J. Bras. Nefrol.

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Introduction and Objective: Maximal inspiratory and expiratory pressures (PI max and PE max ) are used to assess the integrity of respiratory muscles by measuring their strength. The aim of this study was to assess the immediate influence of hemodialysis (HD) on respiratory muscle strength by measuring PI max and PE max , investigating the integrity of that musculature and/or the presence of muscular weakness. Method: A prospective, crosssectional study was carried out on a convenience sample of 35 patients with chronic kidney disease (26 men and 9 women; mean age, 51.7 ± 14.7 years) at the Nephrology Division of the Hospital Universitário Alzira Vellano, in the city of Alfenas, in the state of Minas Gerais, Brazil. Patients had their PI max and PE max taken in the seated position (at 90°) by using a digital manovacuometer (MVD 300®) attached to a notebook for reading and recording data obtained before and after the HD session. Results: Both PI max and PE max were lower than the values predicted for pre-and post-HD (p < 0.0001). Comparing the values obtained pre-HD and post-HD, PImax showed a slight improvement (p = 0.0420), evidenced only in patients with pre-HD values below 60 cmH 2 O (Wilcoxon; p = 0.0480). Post-HD PE max did not differ from the pre-HD measure (p = 0.4987). Conclusion: The CKD patients showed a serious impairment of their respiratory muscle function, and only one isolated HD session could not significantly improve their maximum respiratory pressures. A slight improvement in the inspiratory strength was observed in patients whose PI max was lower than 60 cm-H 2 O before the procedure.

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Respiratory Muscle Weakness in Uremic Patients under Continuous Ambulatory Peritoneal Dialysis

Cited by 45 publications

References 5 publications

High-Volume Peritoneal Dialysis in Acute Kidney Injury

High-Volume Peritoneal Dialysis in Acute Kidney Injury

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

Avaliação das pressões respiratórias máximas em pacientes renais crônicos nos momentos pré e pós-hemodiálise

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