The Impact of Renal Replacement Therapy on FeNO Levels and Pulmonary Function in End-Stage Renal Disease Patients

Renal replacement therapy (RRT) is crucial for end-stage renal disease, yet its pulmonary effects remain unclear. Fractional exhaled nitric oxide (FeNO) serves as a biomarker for airway inflammation. This study evaluates FeNO levels in hemodialysis (HD) and peritoneal dialysis (PD) patients and their relationship with pulmonary function.

RRT patients aged 18-65, followed for at least 2 years in our nephrology clinic, were included. FeNO tests were performed after routine blood sampling. The study comprised 110 patients: 50 HD, 30 PD, and 30 controls.

FeNO levels before and after dialysis were statistically significantly higher in HD patients compared to PD patients (p = < 0.001 for both). Exhaled NO levels measured in the control group were 7.6 ± 5.2 ppb and were statistically significantly lower compared to HD patients before and after dialysis (p = < 0.001 for both). A negative correlation was observed between FeNO and FEV1 and FVC percent (R = -0.807, p = 0.01; R = -0.801, p = 0.01, respectively). A positive correlation was observed between exhaled NO levels before and after dialysis and ΔFVC, ΔFEV1, and ΔPEF25-75 (R = 0.74, p = 0.01; R = 0.74, p = 0.01; R = 0.89, p = 0.01, respectively).

This study showed that FeNO levels were significantly higher in HD patients before and after RRT compared to PD and healthy controls, suggesting a greater impact of HD on airway inflammation. FeNO measurement may serve as a biomarker for monitoring pulmonary health in RRT patients.