Navari Kazem, Farshidi Hossein, Pour-Reza-Gholi Fatemeh, Nafar Mohsen, Zand Saeed, Sohrab Pour Hamid, Eqbal Eftekhaari Tasnim
Division of Pulmonology and Critical Care, Department of Internal Medicine, Shahid Labbafinejad Medical Center, Shahid Beheshti University (MC), Tehran, Iran.
Iran J Kidney Dis. 2008 Jul;2(3):149-53.
End-stage renal disease causes impairment of all body organs including the heart and the lung. The main problems in the afflicted patients are pulmonary edema due to increased permeability of the capillaries, intravascular and interstitial volume overload, hypertension, and congestive heart failure. These changes cause altered physiologic and mechanical function of the lungs and subsequently increase in airway resistance. We aimed to study the impact of hemodialysis on spirometry parameters.
In a cross-sectional study performed on 41 patients on maintenance hemodialysis, spirometry was done before and after the dialysis session. The patients were on either acetate or bicarbonate hemodialysis with the same method, dialysis machine, and duration of dialysis. Alterations in spirometry parameters including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and maximal midexpiratory flow rate were determined and their relation with serum electrolytes, serum creatinine, blood urea nitrogen, and hemoglobin were analyzed.
Twenty-nine patients undergoing dialysis with bicarbonate dialysate and 21 on dialysis with acetate were compared. Improvement in spirometry parameters was only significant in patients undergoing dialysis with bicarbonate dialysate. All spirometry parameters showed significant increases in the bicarbonate group except for the FEV1/FVC ratio. Furthermore, significant increase in these parameters was only prominent in the men. Postdialysis weight reduction and laboratory indexes had no significant correlation with improvement of spirometry parameters.
Dialysis with bicarbonate dialysate causes significant improvement in spirometry parameters in men on maintenance dialysis. This effect might be independent of the effect of removing the volume overload by dialysis.
终末期肾病会损害包括心脏和肺在内的所有身体器官。患病患者的主要问题是毛细血管通透性增加导致的肺水肿、血管内和间质容量超负荷、高血压以及充血性心力衰竭。这些变化会导致肺的生理和机械功能改变，进而增加气道阻力。我们旨在研究血液透析对肺量计参数的影响。
在一项对41例维持性血液透析患者进行的横断面研究中，在透析 session 前后进行肺量计检查。患者采用相同的方法、透析机和透析 duration 进行醋酸盐或碳酸氢盐血液透析。确定肺量计参数的变化，包括第一秒用力呼气量（FEV1）、用力肺活量（FVC）、FEV1/FVC 比值和最大呼气中期流速，并分析它们与血清电解质、血清肌酐、血尿素氮和血红蛋白的关系。
比较了29例接受碳酸氢盐透析液透析的患者和21例接受醋酸盐透析的患者。仅接受碳酸氢盐透析液透析的患者肺量计参数有显著改善。除 FEV1/FVC 比值外，碳酸氢盐组的所有肺量计参数均显著增加。此外，这些参数的显著增加仅在男性中明显。透析后体重减轻和实验室指标与肺量计参数的改善无显著相关性。
使用碳酸氢盐透析液进行透析可使维持性透析男性的肺量计参数得到显著改善。这种效应可能独立于透析去除容量超负荷的效应。
