Pulmonary function with acute loss of excess lung water by hemodialysis in patients with chronic uremia

• Published in: The American journal of medicine Vol. 55; no. 2; pp. 134 - 141
• Main Authors: Zidulka, A., Despas, P.J., Milic-Emili, J., Anthonisen, N.R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.1973
• Subjects: Adult; Airway Resistance; Body Weight; Carbon Dioxide - blood; Chronic Disease; Humans; Kidney Failure, Chronic - physiopathology; Lung - physiopathology; Oxygen - blood; Perfusion; Pulmonary Diffusing Capacity; Pulmonary Ventilation; Radioisotopes; Renal Dialysis; Smoking; Spirometry; Time Factors; Uremia - physiopathology; Vital Capacity; Water; Xenon
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/0002-9343(73)90161-7

We studied lung function in six patients with advanced renal failure who were on a chronic hemodialysis program. With the patients in the seated position, both before and after hemodialysis, we measured lung volumes, maximal mid-expiratory flow rates (MMFR) and alveolar arterial oxygen differences (A-a DO 2). Using xenon 133 ( 133Xe) we also studied regional lung function and the volume at which “airway closure” began (“closing capacity”). Before dialysis a restrictive pattern was observed, with normal MMFR and reduced lung volumes. With removal of body fluid the residual volume decreased further with a concomitant increase in vital capacity and in MMFR. Before dialysis the majority of patients had an increased residual volume in basal lung regions which decreased after dialysis. In five of six patients the “closing capacities” decreased with dialysis. These results reflected reversible premature airway closure and gas trapping at the lung bases perhaps due to accumulation of edema around small airways. In addition, most of the patients had decreased ventilation and perfusion at the lung bases which improved with dialysis. Little change occurred, however, in the A-a DO 2 with dialysis.