Why Is Your Patient Still Short of Breath? Understanding the Complex Pathophysiology of Dyspnea in Chronic Kidney Disease

Abstract

Dyspnea is one of the most common symptoms associated with CKD. It has a profound influence on the quality of life of CKD patients, and its underlying causes are often associated with a negative prognosis. However, its pathophysiology is poorly understood. While hemodialysis may address fluid overload, it often does not significantly improve breathlessness, suggesting multiple and co-existing alternative issues exist. The aim of this article is to discuss the main pathophysiologic mechanisms and the most important putative etiologies underlying dyspnea in CKD patients. Congestive heart failure, unrecognized chronic lung disease, pulmonary hypertension, lung fibrosis, air microembolism, dialyzer bio-incompatibility, anemia, sodium, and fluid overload are potential frequent causes of breathing disorders in this population. However, the relative contributions in any one given patient are poorly understood. Systemic inflammation is a common theme and contributes to the development of endothelial dysfunction, lung fibrosis, anemia, malnutrition, and muscle wasting. The introduction of novel multimodal imaging techniques, including pulmonary functional magnetic resonance imaging with inhaled contrast agents, could provide new insights into the pathophysiology of dyspnea in CKD patients and ultimately contribute to improving our clinical management of this symptom.

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…Extrapolating from current general population hypertension guidelines may be reasonable, but such guidelines do not account for differences in cardiovascular risk in dialysis patients. Specifically, numerous observational studies [12][13][14] and the Blood-Pressurein-Dialysis study 28 Technologies HD and PD Investigate whether bioimpedance-guided volume management improves patient-centered and hard clinical outcomes HD and PD Investigate whether lung ultrasound-guided volume management improves patient-centered and hard clinical outcomes HD Investigate whether blood volume monitoring, temperature cooling, hemodiafiltration, UF profiling, and isolated UF have a benefit in hemodynamic stability, and whether this translates into benefits in hard outcomes Volume-related patient symptoms and experiences HD and PD Collect data on quality of life and symptoms in all future studies related to BP and/or volume management HD and PD Investigate the underlying physiology of symptoms 27…”

Pulmonary artery pressure as a method for assessing hydration status in an anuric hemodialysis patient – a case report

“…The PEPPER-trial suggests a great proportion of PH in chronic kidney disease (CKD) patients to be related to fluid status, as they found most of the hemodialysis patients suffering from PH to have post-capillary hypertension [5]. This is usually related to fluid overload and left ventricular dysfunction [8]. The PEPPER-trial found post-dialytic mPAP to be 55 ± 17 mmHg in their dialysis population [5].…”

Zinc-α2-Glycoprotein Is An Inhibitor Of Amine Oxidase Copper-Containing 3

“…Modification of the carbohydrate content of recombinant ZAG in the presence of CoCl 2 provokes the notion that differences in ZAG glycosylation are co-regulated by oxygen-sensing factors and that these differences affect biological function in vivo . Diseases associated with a rise in ZAG levels, such as cancer, AIDS [37] and chronic heart and kidney disease [40,133,134], often manifest dyspnea due to highly interdependent symptoms such as fatigue, physical impairment, pulmonary hypertension, lung infections and heart failure [135–137]. It would be interesting to observe whether overall oxygen saturation affects the glycosylation pattern of ZAG.…”