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Sustained ventilation: perfusion imbalance during hemodialysis
The International Journal of Pediatric Nephrology
|June 1, 1983
Summary
Hemodialysis in children may cause hypoxemia due to ventilation-perfusion mismatch. This study in pediatric patients found sustained gas exchange abnormalities during hemodialysis (HD) at altitude.
Area of Science:
- Pediatric Nephrology
- Pulmonary Physiology
- Dialysis Medicine
Background:
- Chronic renal failure necessitates renal replacement therapy in children.
- Hemodialysis (HD) is a common treatment for pediatric end-stage renal disease.
- Understanding the pulmonary effects of HD is crucial for patient management.
Purpose of the Study:
- To investigate the central and pulmonary effects of hemodialysis on gas exchange in pediatric patients.
- To evaluate changes in ventilation and perfusion during HD in children.
- To identify potential mechanisms for dialysis-related hypoxemia.
Main Methods:
- Studied five children (6-15 years) on chronic HD.
- Measured dialysate and arterial blood gases, end-tidal CO2, and minute ventilation pre- and post-HD initiation.
- Calculated arterial-alveolar CO2 gradient (aADCO2) to assess ventilation-perfusion (V/Q) status.
Main Results:
- Minute ventilation remained unchanged during HD.
- The aADCO2 significantly increased post-HD, indicating a V/Q mismatch.
- A significant inverse relationship was observed between aADCO2 and arterial pO2.
Conclusions:
- Dialysis-related hypoxemia in these pediatric patients appears linked to sustained V/Q mismatch.
- A decrease in pulmonary perfusion may contribute to the observed gas exchange abnormalities.
- Findings suggest potential implications for HD protocols in children, especially at altitude.