What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: End-stage renal disease on hemodialysis (n=100). Intervention: Long duration of hemodialysis (≥ 5 years) vs. Short duration of hemodialysis (< 5 years). Primary outcome: Ventilatory restriction (OR 6.093, p=0.007).

November 4, 2020Open Access

Duration of hemodialysis associated with cardio-respiratory dysfunction and breathlessness: a multicenter study

Q: What are the key findings of this study?

Long duration of hemodialysis (≥ 5 years) was associated with a significantly increased risk of ventilatory restriction compared to short duration (OR 6.093, p=0.007).

KYKornanong YuenyongchaiwatThammasat University PVPhatsara VasinsarunkulThammasat University PPPhoomipat PhongsukreeThammasat University

Key Result

Long duration of hemodialysis (≥ 5 years) was associated with a significantly increased risk of ventilatory restriction compared to short duration (OR 6.093, p=0.007).

Study Design

Type

Cross-Sectional (n=100)

Multicenter

Yes

Structured PICO

Does long duration of hemodialysis worsen respiratory function and breathlessness in hemodialysis patients?

Population

100 patients aged 30-75 years with end-stage renal disease undergoing hemodialysis for at least 3 months, assessed for respiratory function and breathlessness.

Exposure

Long duration of hemodialysis (≥ 5 years)

Comparator

Short duration of hemodialysis (< 5 years)

Outcome

Respiratory function (MIP, MEP, FVC, FEV1, FEV1/FVC), functional capacity (6-minute walk test), and sensation of breathlessnesssurrogate

Longer duration of hemodialysis (≥ 5 years) is associated with significantly worse respiratory muscle strength, pulmonary function, and increased breathlessness.

Main Result

Odds Ratio: 6.093

p-value: p=0.007

Limitations

Cross-sectional design cannot establish causal relationships
Confounding factors such as volume overload, laboratory analysis of renal function, and comorbidity were not recorded
Other investigations such as arterial blood gas or chest X-ray were not reported
Participants were only clinically stable, limiting generalizability to the broader CRF population
Sample size was not calculated a priori

Abstract

Background Patients with hemodialysis suffer with protein-energy wasting and uremic myopathy lead to lack of physical activity and poor functional performance. However, ventilation abnormality in patients undergone hemodialysis remains controversial regarding the respiratory impairment. Therefore, the study aimed to determine the effect of duration of dialysis on respiratory function. Methods A multicenter study with cross-sectional study was designed in four hemodialysis outpatient clinics. Respiratory muscle strength (i.e., maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)) pulmonary function test (i.e., forced vital capacity (FVC), forced expiratory volume in one second (FEV 1 ) and FEV 1 /FVC ratio), functional capacity (6-minute walk test) and sensation of breathlessness were assessed prior to dialysis. Results A total of 100 hemodialysis patients were recruited with 38 females and 62 males. An average of duration of hemodialysis was 5.93± 4.96 years. Decreased MIP values, FEV 1 values, FVC values, %FEV 1 and %FVC were noted in patients with long duration of dialysis (defined as ≥ 5 years of dialysis) compared to those with short duration of dialysis (p s < .05). In addition, increased sensation of breathlessness was observed in patients with long duration of dialysis ( p < .05). Furthermore, participants with long duration of dialysis had an increased risk of ventilatory restriction (OR 6.093, p = .007).

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