Key result
Incentive spirometry yields ~100% greater improvement in diaphragmatic excursion vs standard care in hemodialysis patients.
Why the study?
Diaphragmatic dysfunction in hemodialysis patients is a scarcely studied issue, and the role of incentive spirometry in its management is unclear.
Does incentive spirometry training improve diaphragmatic excursion in hemodialysis patients with diaphragmatic dysfunction?
RCT (n=100)
Single-blind
Computer-generated random tables and sealed envelope technique
No
Does incentive spirometry training improve diaphragmatic excursion in hemodialysis patients with diaphragmatic dysfunction?
Absolute Event Rate: 0.72% vs 0.36%
p-value: p=<0.001
Incentive spirometry training significantly improves diaphragmatic excursion in hemodialysis patients with diaphragmatic dysfunction.
Supports incentive spirometry in hemodialysis patients with diaphragmatic dysfunction; extends respiratory training evidence in chronic kidney disease.
Background Diaphragmatic dysfunction (DD) in hemodialysis patients is a scarcely studied issue. Incentive spirometry (IS) is a commonly prescribed maneuver used to prevent or manage pulmonary complications. The present study aimed to identify the prevalence and risk factors of DD in 100 HD patients. Moreover, we assessed the role of IS in management of DD in those patients. Methods The present study followed a hybrid design with two phases. In the first cross-sectional phase, 100 consecutive maintenance HD patients for at least 3 years were evaluated for the presence of DD using ultrasound. In the second interventional phase, patients with DD (n = 43) were randomly assigned to receive IS (n = 22) or standard care (n = 21) for management of DD. Results Comparison between patients with DD and patients without regarding clinical and laboratory data revealed that the former group had significantly higher frequency of males [29 (67.4%)/14 (32.6%) vs. 26 (45.6%)/31 (54.4%), p = 0.03] with lower BMI [23.8 ± 3.8 vs. 26.3 ± 3.5 kg/m2, p < 0.001] and longer HD duration (82.2 ± 42.1 vs. 64.8 ± 36.9 months, p = 0.031). Moreover, it was noted that DD group had significantly higher frequency of patients with moderate/severe malnutrition (81.4% vs. 45.6%, p = 0.005), lower Hb levels (9.6 ± 1.5 vs. 10.3 ± 1.4 gm/dL, p = 0.011), lower albumin levels (3.4 ± 0.4 vs. 4.1 ± 0.5 gm/dL, p < 0.001) and higher hsCRP levels [median (IQR) 113.6 (90.9–130.4) vs. 91.1 (50.9–105.6) mg/dL, p < 0.001] as compared to patients without DD. While no significant differences were found between patients receiving study interventions at baseline, patients submitted to IS training showed significant improvement of diaphragmatic excursion measurements as compared to the standard care group. Conclusions In conclusion, DD is commonly encountered in HD patients. Probable risk factors include longer HD duration and low albumin levels. Use of IS can improve diaphragmatic excursion in affected patients.
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Ahmed et al. (2023) conducted an RCT in Hemodialysis with diaphragmatic dysfunction (n=100). Incentive spirometry vs. Standard care was evaluated on Change in right tidal diaphragmatic excursion at 8 weeks (cm) (p=<0.001). Incentive spirometry training for 8 weeks significantly improved right tidal diaphragmatic excursion (mean change 0.72 cm vs 0.36 cm, p<0.001) compared to standard care in hemodialysis patients with diaphragmatic dysfunction.
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