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Pulmonary leukosequestration without hypoxemia during hemodialysis
E A Ross1, D Tashkin, D Chenoweth
1Nephrology Section Long Beach VAMC, California.
The International Journal of Artificial Organs
|November 1, 1987
Summary
Hypoxemia during dialysis is common. Acetate dialysate causes hypoxemia later by reducing alveolar ventilation, not early lung leukosequestration.
Area of Science:
- Nephrology
- Pulmonary Medicine
- Nuclear Medicine
Background:
- Dialysis-associated hypoxemia is a significant clinical issue with unclear mechanisms.
- Understanding hypoxemia during hemodialysis is crucial for patient safety and treatment optimization.
Observation:
- White blood cells were labeled with 111Indium-oxine to track lung localization during hemodialysis.
- Patients underwent hemodialysis using either acetate or bicarbonate dialysate baths.
- Early changes included neutropenia, complement activation, and lactoferrin elevation, with lung radionuclide uptake.
Findings:
- Pulmonary leukosequestration occurred early with both dialysate types but did not impair gas exchange.
- Significant hypoxemia developed later, specifically during acetate dialysis.
- Acetate-induced hypoxemia was linked to a decreased respiratory exchange ratio and alveolar hypoventilation.
Implications:
- Early pulmonary leukosequestration is not the primary cause of dialysis-associated hypoxemia.
- Alveolar hypoventilation is the likely mechanism for hypoxemia during acetate dialysis.
- Findings suggest careful consideration of dialysate buffer choice in patients prone to hypoxemia.