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Pulmonary function in children with chronic renal failure
K Paul1, G Mavridis, K E Bonzel
1University Children's Hospital Heidelberg, Federal Republic of Germany.
Insights
Children with chronic renal failure often experience reduced lung volumes, impacting vital capacity (VC) and forced expiratory volume in 1 second (FEV-1). Lung function generally remains stable during dialysis procedures.
Area of Science:
- Pediatric Nephrology
- Pulmonary Function Testing
Background:
- Chronic renal failure (CRF) can affect multiple organ systems, including pulmonary function in children.
- Previous studies have indicated potential respiratory complications in pediatric CRF patients, but comprehensive lung volume assessments are limited.
Purpose of the Study:
- To evaluate lung volumes, specifically vital capacity (VC) and forced expiratory volume in 1 second (FEV-1), in a cohort of children with chronic renal failure.
- To compare lung function across different stages of renal replacement therapy: conservative treatment (CT), hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD), and post-transplantation (TP).
Main Methods:
- Pulmonary function was assessed using spirometry to measure VC and FEV-1 in 45 children with CRF and 10 healthy controls.
- Residual volume (RV) was additionally measured in CAPD patients.
- Patients were stratified into CT, HD, CAPD, and TP groups.
Main Results:
- A significant proportion of CRF patients (38% for VC, 52% for FEV-1) exhibited lung volumes below predicted normal values (P < 0.05).
- Lung volumes were lowest in the CT group and highest in the TP group.
- Median FEV-1 was significantly reduced in CT (79%) and HD (82%) patients compared to predicted values (P < 0.05).
- FEV-1 showed a significant increase during hemodialysis sessions.
Conclusions:
- Lung volumes are frequently diminished in children with chronic renal failure.
- Pulmonary function parameters, including FEV-1, remain relatively stable during dialysis procedures (HD and CAPD).
- Lung function appears to improve following renal transplantation.
Abstract:
Lung volumes were measured in 45 children with chronic renal failure and compared to 10 healthy controls. Six patients were receiving conservative treatment (CT), 11 were undergoing regular haemodialysis (HD), 8 were on continuous ambulatory peritoneal dialysis (CAPD) and 20 were post transplantation (TP). We measured vital capacity (VC) and forced expiratory volume in 1 s (FEV-1) with a bell spirometer. In addition residual volume (RV) was determined in CAPD patients. VC and FEV-1 values below the lower limit of predicted normal values from healthy children with the same body height were found in 38% and 52% of all patients respectively (P less than 0.05). Median values of VC and FEV-1 were lowest in CT and highest in TP patients. Median FEV-1 was significantly reduced to 79% of predicted values in CT and to 82% in HD patients (P less than 0.05). No correlation was found between FEV-1 and haemoglobin levels or the concomitant use of beta-blocking agents. During a HD session mean FEV-1 increased significantly. In CAPD patients the routine filling of the abdomen was followed by an 11% decrease of RV (non significant) while the other parameters remained stable. It is concluded that lung volumes are frequently reduced in chronic renal failure but remain essentially stable during the dialysis procedures.