Evaluation of pulmonary function in children with end stage renal disease on dialysis using spirometry and serum endothelin-1 level

Abstract

C hronic kidney disease (CKD), in fact, is not only a localized disease, but also affects virtually all organ systems, especially at the late stage of the disease. Among these, respiratory system disorders are one of the most prevalent complications in ESRD patients. The relationship between the kidneys and the lungs are clinically important in health and disease. Complications such as pulmonary edema and pleural effusion are common. Also, pulmonary fibrosis and calcification, pulmonary hypertension, hemosiderosis, and pleural fibrosis may occur. Some of these complications are related to alterations in volume status, plasma oncotic pressure, immune function, bone and mineral metabolism, and concurrent heart failure in those patients; although the precise mechanisms in some other issues are not well understood. The aim of this study was to measure spirometry parameters in children with end stage renal disease before and after dialysis, to investigate the effect of dialysis on ventilatory lung functions of those patients and to measure endothelin-1 level in those patients before and after dialysis and correlate its level with their spirometry parameters. This study was conducted on 30 patients of cross matched for age and gender diagnosed ESRD recruited from the Hemodialysis Unit, Children’s Hospital, Ain Shams University after obtaining the required permissions and informed consent from the participating patients during the period from (April 2017) until (September 2018), divided into two groups, group 1 including 15 patients on hemodialysis and group 2 including 15 patients on hemodiafiltration. Regarding pre-dialysis ventilatory assessment of group 1 patients’ our results showed that 11 (73.3%) patients were suffering of restrictive lung function while the other 4 (26.7%) were having normal respiratory function. While in group 2 patients’ 9 (60%) patients were complaining of restrictive lung function, 1 (6.7%) were suffering of obstructive pulmonary function, 1 (6.7%) patient were suffering of mixed “restrictive and obstructive” lung disease, and 4 (26.7%) patients’ were having normal respiratory function.