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Breathlessness worsened by haemodialysis
Rizna Abdul Cader1, Kanagerajan Thoriappa1, Rozita Mohd1
1Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Respiratory Medicine Case Reports
|November 13, 2018
Summary
Patients with chronic lung disease and end-stage renal disease on dialysis may experience worsening shortness of breath due to alveolar hypoventilation during hemodialysis. This condition, exacerbated by the dialysis process, requires careful management and potentially shorter treatment sessions.
Area of Science:
- Nephrology
- Pulmonology
- Critical Care Medicine
Background:
- A 54-year-old female with chronic lung disease on long-term oxygen therapy and end-stage renal disease (ESRD) on maintenance hemodialysis presented with progressive dyspnea.
- The patient's symptoms were refractory to adjustments in dry weight and anemia treatment, and consistently worsened during hemodialysis sessions.
Observation:
- Hemodialysis sessions were prematurely terminated due to worsening shortness of breath, despite no evidence of chronic fluid overload.
- Computed tomography pulmonary angiography ruled out pulmonary embolism and showed chronic fibrotic lung changes.
Findings:
- Hypoxemia was attributed to underlying chronic lung disease exacerbated by alveolar hypoventilation during hemodialysis.
- Symptoms showed slight improvement with supplemental oxygen but necessitated reducing dialysis duration to 3 hours.
Implications:
- Highlights the potential for hemodialysis to worsen respiratory function in patients with pre-existing lung disease.
- Suggests a need for closer monitoring of respiratory status during dialysis in this vulnerable population.
- Underscores the importance of considering alveolar hypoventilation as a cause of dyspnea in ESRD patients undergoing dialysis.
