Zusammenfassung
Pathologische Veränderungen der Lungenfunktion bei Dialysepatienten können Folge einer zugrundeliegenden primären Lungenerkrankung sein. Der Einfluss der Urämie auf die Lungenfunktion und die Effekte der Dialyse sind jedoch nicht ausreichend geklärt. Ziel unserer Untersuchungen war es, akute Auswirkungen einer Bikarbonat Hämodialyse unter Verwendung zweier Dialysemembranen mit unterschiedlicher Biokompatibilität auf die Lungenfunktion bei unselektierten chronischen Hämodialysepatienten nachzuweisen. Vierzehn stabile Dialysepatienten ohne akute Lungenerkrankung nahmen an der Untersuchung teil. Acht Patienten hatten eine restriktive und ein Patient eine obstruktive Ventilationsstörung. Es wurde ein prospektiver Vergleich einer zellulosischen low-flux Dialysemembran mit einer synthetischen high-flux Membran durchgeführt (2 Sitzungen pro Membran im Abstand von einer Woche). Die Spirometrie (VCmax, FEV1, FEF25–75%, PEF) wurde vor und nach der Dialysesitzung durchgeführt. Der Atemwegswiderstand wurde vor, während und nach der Hämodialyse mittels der Unterbrecher Methode (Rocc) oder der Impuls-Oszillometrie (R5Hz, R20Hz) bestimmt. Unabhängig von der Wahl der Dialysemembran hatte eine Hämodialysesitzung keinen akuten Einfluss auf die Lungenfunktion (Volumina, Atemwegswiderstand). Keiner unserer Patienten zeigte eine Bronchokonstriktion oder Verschlimmerung der obstruktiven Ventilationsstörung als Folge der geringen Biokompatibilität der Zellulosemembran. Weder die spirometrischen Daten noch die Messungen des Atemwegswiderstands mit zwei unterschiedlichen Methoden zeigten relevante Veränderungen der Lungenfunktion während der Dialyse. Veränderungen des Volumenstatus oder die Dauer an der Dialyse hatten keinen Einfluss auf die gemessenen Lungenfunktionsparameter. Klinisch relevante Veränderungen der Lungenfunktion durch die Hämodialyse treten weder bei urämischen Patienten mit normaler noch bei Patienten mit eingeschränkter Lungenfunktion auf. Die Dialyse ist ein sicheres Nierenersatzverfahren auch bei Patienten mit Lungenerkrankungen.
Summary
Impaired lung function in hemodialysis patients may be caused by an underlying pulmonary disease; however, the impact of uremia and the effects of dialysis treatment are not well understood. Our investigation aimed to characterize the acute effects of bicarbonate hemodialysis using membranes differing in biocompatibility on various parameters of lung function in unselected uremic patients maintained on regular hemodialysis. Fourteen clinically stable hemodialysis patients without acute lung disease were included in the study. Restrictive lung disease was present in eight of 14 cases and obstructive lung disease in one patient. A cellulose dialyzer membrane and a synthetic high-flux dialyzer membrane were each tested twice (two sessions one week apart). Spirometry (VCmax, FEV1, FEF25–75%, PEF) was carried out before and after hemodialysis. Resistance was determined with the interrupter technique and with the impulse oscillation system (R5Hz, R20Hz) before, during and after hemodialysis. Our comparative investigation of two dialyzer membranes found that bioincompatibility of dialysis had no acute adverse effects on lung function in our heterogenous population of dialysis patients. None of our patients experienced bronchoconstriction or aggravation of obstructive lung disease as a result of poor biocompatibility of the dialyzer membrane. Spirometric data and resistance measurements by two different methods showed no relevant changes during the dialysis procedure. There was no correlation between lung function parameters and interdialytic changes in body weight or duration on hemodialysis. Regardless of the membrane used, the hemodialysis procedure does not acutely affect lung function in uremic patients on maintenance hemodialysis. Hemodialysis is a safe procedure even in uremic patients with pre-existing lung disease.
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Lang, S., Becker, A., Fischer, R. et al. Acute effects of hemodialysis on lung function in patients with end-stage renal disease. Wien Klin Wochenschr 118, 108–113 (2006). https://doi.org/10.1007/s00508-006-0564-7
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DOI: https://doi.org/10.1007/s00508-006-0564-7