Skip to main content


Log in

Impact of continuous positive airway pressure (CPAP) on the respiratory capacity of chronic kidney disease patients under hemodialysis treatment

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript



Chronic kidney disease (CKD) patients on long-term dialysis present changes in pulmonary function and respiratory muscle strength, negatively influencing physical capacity.


To analyze the impact of a continuous positive airway pressure (CPAP) protocol on the respiratory capacity of CKD patients under hemodialysis.


A randomized clinical trial was conducted involving 40 CKD patients 19–83 years old divided into two groups: control (n = 20) and CPAP (n = 20). Subjects were assessed on the respiratory muscle function test, maximal respiratory pressures, peak flow and 6-min walk test, at baseline and again at the 2-month follow-up. CPAP group patients were submitted to CPAP protocol (PEEP: 5 cm H2O, flow: 15 L/min, FiO2: 33 %) three times per week during hemodialysis sessions.


The CPAP group showed higher forced vital capacity, forced expiratory volume in one second, peak expiratory flow, maximal inspiratory pressure, peak flow, as well as lower systolic blood pressure, heart rate, respiratory rate and Borg scale, in addition to a longer distance travelled on the 6-min walk test, compared with the control group.


The introduction of a CPAP protocol during hemodialysis sessions had a positive impact on pulmonary function and physical capacity in CKD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Viana J, Kosmadakis GC, Watson EL, Bevington A, Feehally J, Bishop NC et al (2014) Evidence for anti-inflammatory effects of exercise in CKD. J Am Soc Nephrol 25:1–10

    Article  Google Scholar 

  2. Gómez-Fernández P, Sánchez Agudo L, Calatrava JM, Escuin F, Selgas R, Martínez ME et al (1984) Respiratory muscle weakness in uremic patients under continuous ambulatory peritoneal dialysis. Nephron 36(4):219–223

    Article  PubMed  Google Scholar 

  3. Heiwe S, Jacobson SH (2011) Exercise training for adults with chronic kidney disease (Review). The Cochrane Collaboration 1–396

  4. Pierson DJ (2006) Respiratory considerations in patient with renal failure. Respir Care 51(4):413–422

    PubMed  Google Scholar 

  5. Siafakas NM, Argyrakopoulos T, Andreopoulos K, Tsoukalas G, Tzanakis N, Bouros D (1995) Respiratory muscle strength during continuous ambulatory peritoneal dialysis (CAPD). Eur Respir J 8(1):109–113

    Article  CAS  PubMed  Google Scholar 

  6. Dujic Z, Tocilj J, Ljutic D, Eterovic D (1991) Effects of hemodialysis and anemia on pulmonary diffusing capacity. Membrane diffusing capacity and capillary blood volume in uremic patients. Respiration 58:277–281

    Article  CAS  PubMed  Google Scholar 

  7. Huff JS, Whelan TV (1994) CPAP as adjunctive treatment of severe pulmonary edema in patients with ESRD. Am J Emerg Med 12:388–392

    Article  CAS  PubMed  Google Scholar 

  8. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166(1):111–117

    Article  Google Scholar 

  9. Grassmann A, Gioberge S, Moeller S, Brown G (2005) ESRD patients in 2004: global overview of patient numbers treatment modalities and associated trends. Nephrol Dial Transplant 20:2587–2593

    Article  PubMed  Google Scholar 

  10. Zoccali C, Tripepi R, Torino C, Bellantoni M, Tripepi G, Mallamaci F (2013) Lung congestion as a risk factor in end-stage renal disease. Blood Purif 36:184–191

    Article  PubMed  Google Scholar 

  11. Palamidas AF, Gennimata SA, Karakontaki F, Kaltsakas F, Kaltsakas G, Papantoniou I et al (2014) Impact of hemodialysis on dyspnea and lung function in end stage kidney disease patients. Biomed Res Int 2014:212751

    Article  PubMed Central  PubMed  Google Scholar 

  12. Adams GR, Vaziri ND (2006) Skeletal muscle dysfunction in chronic renal failure: effects of exercise. Am J Physiol Renal Physiol 290(4):753–761

    Article  Google Scholar 

  13. Karacan Ö, Tutal E, Çolak T, Sezer S, Eyüboglu FÖ, Haberal M (2006) Pulmonary function in renal transplant recipients and end-stage renal disease patients undergoing maintenance dialysis. Transpl Proc 38:396–404

    Article  CAS  Google Scholar 

  14. Karacan O, Tutal E, Uyar M, Eyüboğlu FO, Sezer S, Ozdemir FN (2004) Pulmonary function in uremic patients on long-term hemodialysis. Ren Fail 26(3):273–278

    Article  PubMed  Google Scholar 

  15. Tovbin D, Heimer D, Mashal A, Degtyar P, Avnon LS (2001) Intradialytic hypercapnic respiratory failure managed by noninvasive assisted ventilation. Am J Nephrol 21:383–385

    Article  CAS  PubMed  Google Scholar 

  16. Bush A, Gabriel R (1991) Pulmonary function in chronic renal failure: effects of dialysis and transplantation. Thorax 46:424–428

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Kirkman DL, Roberts LD, Kelm M, Wagner J, Jibani MM, Macdonald JH (2013) Interaction between intradialytic exercise and hemodialysis adequacy. Am J Nephrol 38:475–482

    Article  CAS  PubMed  Google Scholar 

  18. Cupisti A, Licitra R, Chisari C, Stampacchia G, D’Alessandro C, Galetta F et al (2004) Skeletal muscle and nutritional assessment in chronic renal failure patients on a protein-restricted diet. J Intern Med 255:115–124

    Article  CAS  PubMed  Google Scholar 

  19. Clanton TL, Dixon GF, Drake J, Gadek JE (1985) Effects of breathing pattern on inspiratory muscle endurance in humans. J Appl Physiol 59(6):1834–1841

    CAS  PubMed  Google Scholar 

  20. Wilson SH, Cooke NT, Edwards RH et al (1984) Predicted normal values for maximal respiratory pressures in caucasian adults and children. Thorax 39:535–538

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Fu C, Caruso P, Lucato JJ, Souza R, Schettino GPP, Carvalho CRR (2005) Comparison of two flow generators with a noninvasive ventilator to deliver continuous positive airway pressure: a test lung study. Intensive Care Med 31:1587–1591

    Article  PubMed  Google Scholar 

  22. Koyner JL, Murray P (2010) Mechanical ventilation and the kidney. Blood Purif 29:52–68

    Article  PubMed Central  PubMed  Google Scholar 

  23. Marquez JM, Douglas ME, Downs JB, Wu WH, Mantini EL, Kuck EJ et al (1979) Renal function and cardiovascular responses during positive airway pressure. Anesthesiology 50(5):393–398

    Article  CAS  PubMed  Google Scholar 

  24. Segura-Orti E (2010) Ejercicio en pacientes en hemodiálisis: revisión sistemática de la literatura. Nefrologia 30:236–246

    PubMed  Google Scholar 

  25. Cahalin LP, Mathier MA, Semigran MJ, Dec GW, DiSalvo TG (1996) The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest 10:325–332

    Article  Google Scholar 

  26. Bersten AD, Holt AW, Vedig AE, Skowronski GA, Baggoley CJ (1991) Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 325(26):1825–1830

    Article  CAS  PubMed  Google Scholar 

  27. Mehta S, Hill NS (2001) Noninvasive ventilation. Am J Respir Crit Care Med 163:540–577

    Article  CAS  PubMed  Google Scholar 

  28. Bavbek N, Akay H, Uz B, Turgut F, Kanbay M, Senes M et al (2010) The effects of L-carnitine therapy on respiratory function test in chronic hemodialysis patients. Ren Fail 32:157–161

    Article  CAS  PubMed  Google Scholar 

  29. Koufaki P, Mercer TH, Naish PF (2002) Effects of exercise training on aerobic and functional capacity of end-stage renal disease patients. Clin Physiol Funct Imaging 22(2):115–124

    Article  PubMed  Google Scholar 

  30. Kemp GJ, Crowe AV, Anijeet HK, Gong QY, Bimson WE, Frostick SP et al (2004) Abnormal mitochondrial function and muscle wasting but normal contractile efficiency in haemodialysed patients studied non-invasively in vivo. Nephrol Dial Transplant 19:1520–1527

    Article  PubMed  Google Scholar 

  31. Schiffl H, Lang SM, Fischer R (2002) Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 346:305–310

    Article  PubMed  Google Scholar 

  32. Rahgoshai R, Rahgoshai R, Khrosraviani AAN, Solouki M (2010) Acute effects hemodialysis on pulmonary patients with end-stage renal disease. IJKD 4:214–217

    PubMed  Google Scholar 

  33. Neylon M, Marshall JM, Johns EJ (1997) The effects of chronic hypoxia on renal function in the rat. J Physiol 501(Pt 1):243–250

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. Enright PL, McBurnie MA, Bitter V, Tracy RP, McNamara R, Arnold A, Newman AB (2003) Cardiovascular Health Study: the 6-min walk test: a quick measure of functional status in elderly adults. Chest 123(2):387–398

    Article  PubMed  Google Scholar 

  35. Johansen KL, Painter P (2012) Exercise in individuals with CKD. Am J Kidney Dis 59:126–134

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Vivian Bertoni Xavier.

Additional information

Study conducted at: Dialysis Unit, Santa Casa de Misericórdia de São Paulo, São Paulo (SP)/Brazil.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xavier, V.B., Roxo, R.S., Miorin, L.A. et al. Impact of continuous positive airway pressure (CPAP) on the respiratory capacity of chronic kidney disease patients under hemodialysis treatment. Int Urol Nephrol 47, 1011–1016 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: