Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1991 Jun;46(6):424–428. doi: 10.1136/thx.46.6.424

Pulmonary function in chronic renal failure: effects of dialysis and transplantation.

A Bush 1, R Gabriel 1
PMCID: PMC463189  PMID: 1858080

Abstract

Many possible pulmonary complications of renal disease have been described, but little is known of their physiological importance or the effects on them of different forms of renal replacement therapy. Four groups were recruited, each containing 20 patients. The groups consisted of patients with chronic renal failure before dialysis (group 1); patients receiving continuous ambulatory peritoneal dialysis, never having received a transplant (group 2); patients receiving haemodialysis, never having received a transplant (group 3); and patients after their first successful cadaveric renal transplant (group 4). All were attending the same regional dialysis and transplant unit. None was known to have clinically important lung or chest wall disease. Flow-volume loops were recorded before and after 400 micrograms of salbutamol, and plethysmographic lung volumes and airway conductance and single breath carbon monoxide transfer factor were measured. Only nine of 80 patients had normal lung function. The reductions in spirometric values were minor. Whole lung carbon monoxide transfer factor was reduced in all groups (mean % predicted with 95% confidence intervals: group 1 81.7% (74-89%); group 2 69.7% (62-77%); group 3 87.5% (80-96%); group 4 82.5% (78-87%]. The values were significantly lower in those having continuous ambulatory peritoneal dialysis (group 2). Residual volume was reduced significantly in the group who had undergone renal transplantation (85.7%, 77-94%). There was no correlation between these changes and smoking habit, age, duration or severity of renal failure, duration of treatment, or biochemical derangement. It is concluded that abnormal lung function is common in renal disease. The main change is a reduction in carbon monoxide transfer that persists after transplantation. The likeliest explanation is that subclinical pulmonary oedema progresses to fibrosis before transplantation. The fibrosis may worsen further to cause the reduced residual volume in the recipients of grafts.

Full text

PDF
427

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Belcher N. G., Rees P. J. Changes in pulmonary clearance of technetium labelled DTPA during haemodialysis. Thorax. 1986 May;41(5):381–385. doi: 10.1136/thx.41.5.381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bush A., Gabriel R. The lungs in uraemia: a review. J R Soc Med. 1985 Oct;78(10):849–855. doi: 10.1177/014107688507801012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bush A., Miller J., Peacock A. J., Sopwith T., Gabriel R., Denison D. Some observations on the role of the abdomen in breathing in patients on peritoneal dialysis. Clin Sci (Lond) 1985 Apr;68(4):401–406. doi: 10.1042/cs0680401. [DOI] [PubMed] [Google Scholar]
  4. Carmichael D. J., Hamilton D. V., Evans D. B., Stovin P. G., Calne R. Y. Interstitial pneumonitis secondary to azathioprine in a renal transplant patient. Thorax. 1983 Dec;38(12):951–952. doi: 10.1136/thx.38.12.951. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Comty C. M., Cohen S. L., Shapiro F. L. Pericarditis in chronic uremia and its sequels. Ann Intern Med. 1971 Aug;75(2):173–183. doi: 10.7326/0003-4819-75-2-173. [DOI] [PubMed] [Google Scholar]
  6. Cotes J. E., Dabbs J. M., Elwood P. C., Hall A. M., McDonald A., Saunders M. J. Iron-deficiency anaemia: its effect on transfer factor for the lung (diffusiong capacity) and ventilation and cardiac frequency during sub-maximal exercise. Clin Sci. 1972 Mar;42(3):325–335. doi: 10.1042/cs0420325. [DOI] [PubMed] [Google Scholar]
  7. Craddock P. R., Fehr J., Brigham K. L., Kronenberg R. S., Jacob H. S. Complement and leukocyte-mediated pulmonary dysfunction in hemodialysis. N Engl J Med. 1977 Apr 7;296(14):769–774. doi: 10.1056/NEJM197704072961401. [DOI] [PubMed] [Google Scholar]
  8. Crosbie W. A., Snowden S., Parsons V. Changes in lung capillary permeability in renal failure. Br Med J. 1972 Nov 18;4(5837):388–390. doi: 10.1136/bmj.4.5837.388. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Denison D. M., Du Bois R., Sawicka E. Does the lung work? 6. Pictures in the mind. Br J Dis Chest. 1983 Jan;77(1):35–50. [PubMed] [Google Scholar]
  10. Doak P. B., Becroft D. M., Harris E. A., Hitchcock G. C., Leeming B. W., North J. D., Montgomerie J. Z., Whitlock R. M. Pneumocystis carinii pneumonia--transplant lung. Q J Med. 1973 Jan;42(165):59–71. [PubMed] [Google Scholar]
  11. Gibson D. G. Haemodynamic factors in the development of acute pulmonary oedema in renal failure. Lancet. 1966 Dec 3;2(7475):1217–1220. doi: 10.1016/s0140-6736(66)92302-6. [DOI] [PubMed] [Google Scholar]
  12. Gómez-Fernández P., Sánchez Agudo L., Calatrava J. M., Escuin F., Selgas R., Martínez M. E., Montero A., Sánchez-Sicilia L. Respiratory muscle weakness in uremic patients under continuous ambulatory peritoneal dialysis. Nephron. 1984;36(4):219–223. doi: 10.1159/000183157. [DOI] [PubMed] [Google Scholar]
  13. Hakim R. M., Breillatt J., Lazarus J. M., Port F. K. Complement activation and hypersensitivity reactions to dialysis membranes. N Engl J Med. 1984 Oct 4;311(14):878–882. doi: 10.1056/NEJM198410043111403. [DOI] [PubMed] [Google Scholar]
  14. Handslip P. D., Bone M., Woodhead J. S., Davies B. H. Calcium and phosphate metabolism in sarcoidosis with particular reference to parathyroid function. Br J Dis Chest. 1981 Jan;75(1):55–60. doi: 10.1016/s0007-0971(81)80007-1. [DOI] [PubMed] [Google Scholar]
  15. Lee H. Y., Stretton T. B., Barnes A. M. The lungs in renal failure. Thorax. 1975 Feb;30(1):46–53. doi: 10.1136/thx.30.1.46. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Leong A. S., Disney A. P., Gove D. W. Spallation and migration of silicone from blood-pump tubing in patients on hemodialysis. N Engl J Med. 1982 Jan 21;306(3):135–140. doi: 10.1056/NEJM198201213060303. [DOI] [PubMed] [Google Scholar]
  17. Mootz J. R., Sagel S. S., Roberts T. H. Roentgenographic manifestations of pulmonary calcifications. A rare cause of respiratory failure in chronic renal disease. Radiology. 1973 Apr;107(1):55–60. doi: 10.1148/107.1.55. [DOI] [PubMed] [Google Scholar]
  18. Nidus B. D., Matalon R., Cantacuzino D., Eisinger R. P. Uremic pleuritis--a clinicopathological entity. N Engl J Med. 1969 Jul 31;281(5):255–256. doi: 10.1056/NEJM196907312810507. [DOI] [PubMed] [Google Scholar]
  19. Owens M. W., Kinasewitz G. T., Anderson W. M. Clinical significance of an isolated reduction in residual volume. Am Rev Respir Dis. 1987 Dec;136(6):1377–1380. doi: 10.1164/ajrccm/136.6.1377. [DOI] [PubMed] [Google Scholar]
  20. Rackow E. C., Fein I. A., Sprung C., Grodman R. S. Uremic pulmonary edema. Am J Med. 1978 Jun;64(6):1084–1088. doi: 10.1016/0002-9343(78)90466-7. [DOI] [PubMed] [Google Scholar]
  21. Rashid H. U., Papiha S. S., Agroyannis B., Morley A. R., Ward M. K., Roberts D. F., Kerr D. N. The associations of HLA and other genetic markers with glomerulonephritis. Hum Genet. 1983;63(1):38–44. doi: 10.1007/BF00285395. [DOI] [PubMed] [Google Scholar]
  22. Reyman T. A. Subacute constrictive uremic pericarditis. Am J Med. 1969 Jun;46(6):972–975. doi: 10.1016/0002-9343(69)90098-9. [DOI] [PubMed] [Google Scholar]
  23. Rubini M. E., Cobun J. W., Massry S. G., Shinaberger J. H. Renal osteodystrophy; some therapeutic consideration relative to long-term dialysis and transplantation. Arch Intern Med. 1969 Dec;124(6):663–669. doi: 10.1001/archinte.124.6.663. [DOI] [PubMed] [Google Scholar]
  24. Rutherford W. E., Blondin J., Miller J. P., Greenwalt A. S., Vavra J. D. Chronic progressive renal disease: rate of change of serum creatinine concentration. Kidney Int. 1977 Jan;11(1):62–70. doi: 10.1038/ki.1977.8. [DOI] [PubMed] [Google Scholar]
  25. Schwarz M. I., Whitcomb M. E., French J. B. Significance of an isolated reduction of the residual volume. Am Rev Respir Dis. 1971 Mar;103(3):430–432. doi: 10.1164/arrd.1971.103.3.430. [DOI] [PubMed] [Google Scholar]
  26. Zidulka A., Despas P. J., Milic-Emili J., Anthonisen N. R. Pulmonary function with acute loss of excess lung water by hemodialysis in patients with chronic uremia. Am J Med. 1973 Aug;55(2):134–141. doi: 10.1016/0002-9343(73)90161-7. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES