Pulmonary Aspects of Dialysis Patients

  • Marc E. de Broe
  • Robert R. Lins
  • Wilfried A. De Backer


Patients with acute or end-stage chronic renal failure, whether treated by dialysis or not, frequently develop pulmonary complications such as edema, pleural effusion and infection. In addition, hemodialysis treatment is always accompanied with a variable degree of hypoxemia at the start or towards the end of the treatment session. Respiratory failure secondary to hyperkalemia is a life threatening, fortunately rare complication, in chronic hemodialysis.


Peritoneal Dialysis Dialysis Patient Carpal Tunnel Syndrome Breathing Pattern Respiratory Quotient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Guyton A, Linsey A: Effect of elevated left atrial pressure and decreased plasma protein concentration on the development of pulmonary edema. Circ Res 7: 649, 1959PubMedGoogle Scholar
  2. 2.
    Bright R: Tabular view of the morbid appearance in 100 cases connected with albuminous urine, with observations. Guys Hosp Rep 1: 380, 1836Google Scholar
  3. 3.
    Maher JF: Uremic pleuritis. Am J Kidney Dis 10: 19, 1987PubMedGoogle Scholar
  4. 4.
    Cradio A, Mena A, Figuerdo R, Reige E, Avello F: Late perforation of superior vena cava and effusion caused by central venous catheter. Anaesth Intensive Care 9: 286, 1981Google Scholar
  5. 5.
    Berger HW, Rammohan G, Neff MS, Buhain WJ: Uremic pleural effusion. A study in 14 patients on chronic dialysis. Ann Intern Med 82: 363, 1975Google Scholar
  6. 6.
    Galen MA, Steinberg SM, Lowrie FG, Lazarus JM, Hampers CL, Merrill JP: Hemorrhagic pleural effusion in patients undergoing chronic hemodialysis. Ann Intern Med 82: 359, 1975PubMedGoogle Scholar
  7. 7.
    Rodelas R, Rakowski TA, Argy WP, Schreiner GE: Fibrosing uremic pleuritis during hemodialysis. JAMA 243: 2424, 1980PubMedCrossRefGoogle Scholar
  8. 8.
    Brown CM, Sloan DF, Berns AS, Kanter A: Fibrosing uremic pleuritis during hemodialysis. JAMA 245: 705, 1981PubMedCrossRefGoogle Scholar
  9. 9.
    Cheung AK, Henderson LW: Effects of complement activation by hemodialysis membranes. Am J Nephrol 6: 81, 1986PubMedCrossRefGoogle Scholar
  10. 10.
    Duarte R: Blood pressure, ventilation and lipid imbalance during hemodialysis: effect of dialysate composition. Blood Purify 3: 199, 1985CrossRefGoogle Scholar
  11. 11.
    Eiser A: Pulmonary gas exchange during hemodialysis and peritoneal dialysis: interaction between respiration and metabolism. Am J Kidney Dis 6: 131, 1985PubMedGoogle Scholar
  12. 12.
    Garella S, Chang BS: Hemodialysis-associated hypoxemia. Am J Nephrol 4: 273, 1984PubMedCrossRefGoogle Scholar
  13. 13.
    Sherlock J, Ledwith JK, Letteri J: Hypoventilation and hypoxemia during hemodialysis: reflex response to removal of CO2 across the dialyzer. Trans Am Soc Artif Intern Organs 23: 406, 1977PubMedGoogle Scholar
  14. 14.
    Bischel MD, Scoles BG, Mohler JG: Evidence for pulmonary microembolization during hemodialysis. Chest 67: 335, 1976CrossRefGoogle Scholar
  15. 15.
    Aurigemma NM, Feldman NT, Gottlieb M, Ingram RH, Lazarus JM, Lowrie FG, Arterial oxygenation during hemodialysis. N Engl J Med 291: 871, 1977CrossRefGoogle Scholar
  16. 16.
    Skubitz KM, Craddock PR: Reversal of hemodialysis granulocytopenia and pulmonary leukostasis. A clinical manifestation of selective downregulation of granulocyte response to C5a desarg. J Clin Invest 67: 1383, 1981PubMedCrossRefGoogle Scholar
  17. 17.
    Wathen RL, Ferris FZ, Nagar D, Keshaviah P: An alternative explanation for dialysis-induced arterial hypoxemia. Kidney Int 14: 689, 1978Google Scholar
  18. 18.
    Hampl H, Paeper H, Unger V, Fischer CH, Resa I, Kessel M: Hemodynamic changes during hemodialysis, sequential ultrafiltration and hemofiltration. Kidney Int 18: S83, 1980Google Scholar
  19. 19.
    De Backer WA, Verpooten GA, Borgonjon DA, Vermeire PA, Lins RR, De Broe ME: Hypoxemia during hemodialysis: effects of different membranes and dialysate compositions. Kidney Int 23:738, 1983PubMedCrossRefGoogle Scholar
  20. 20.
    Dolan MJ, Whipp BJ, Davidson WD, Weitzman RE, Wasserman K: Hypopnea associated with acetate hemodialysis: carbon dioxide-flow dependent ventilation. N Engl J Med 305: 72, 1981PubMedCrossRefGoogle Scholar
  21. 21.
    Ikeda T, Hirasawa Y, Aizawa Y, Shibita A, Gejyo F, Ei K: Effect of acetate upon arterial gases. J Dial 3: 135, 1979PubMedGoogle Scholar
  22. 22.
    Eiser AR, Jahamanne D, Kokseng C, Che H, Slifkin RF, Neff MS: Contrasting alterations in pulmonary gas exchange during acetate and bicarbonate hemodialysis. Am J Nephrol 2: 123, 1982PubMedCrossRefGoogle Scholar
  23. 23.
    Oh MS, Uribarri J, Del Monte MI, Heneghan WF, Kee CS, Friedman EA, Carroll HJ: A mechanism of hypoxemia during hemodialysis: consumption of CO2 in metabolism of acetate. Am J Nephrol 5: 366, 1985PubMedCrossRefGoogle Scholar
  24. 24.
    Romaldini H, Rodriguez-Roisin R, Lopez FA, Ziegler TW, Bencowitz HZ, Wagner PD: The mechanism of arterial hypoxemia during hemodialysis. Am Rev Respir Dis 129: 780, 1984PubMedGoogle Scholar
  25. 25.
    Romaldini H, Stabile C, Faro S, Lopes Dos Santos M, Ramos OL, Ribeiro Ratto O: Pulmonary ventilation during hemodialysis. Nephron 32: 131, 1982PubMedCrossRefGoogle Scholar
  26. 26.
    Heyrman RM, De Backer WA, Van Waeleghem JP, Wittesaele WM, De Broe ME: The effect of acetate on ventilation in hemodialysis patients. Nephron 1988 (submitted)Google Scholar
  27. 27.
    Nissenson A: Prevention of dialysis induced hypoxemia by bicarbonate dialysis. Trans Am Soc Artif Intern Organs 26: 339, 1980PubMedGoogle Scholar
  28. 28.
    Raja R, Kramer M, Rosenbaum JL, Bolisay C, Krug M: Prevention of hypotension during isoosmolar hemodialysis with bicarbonate dialysate. Trans Am Soc Artif Intern Organs 26: 375, 1980PubMedGoogle Scholar
  29. 29.
    Van Stone J, Bauer J, Carey J: The effect of dialysate sodium concentration on body fluid distribution during hemodialysis. Trans Am Soc Artif Intern Organs 26: 283, 1980Google Scholar
  30. 30.
    Cohn MA, Rao AS, Broudy M, Birch S, Watson H, Atkins N: The respiratory inductive plethysmograph: a new non-invasive monitor of respiration. Bull Eur Physiopathol Resp 18: 643, 1983Google Scholar
  31. 31.
    Kaplow LS, Goffinet JA: Profound neutropenia during the early phase of hemodialysis. JAMA 203: 1135, 1968PubMedCrossRefGoogle Scholar
  32. 32.
    Craddock PR, Fehr J, Brigham KL, Kronenberg R, Jacobs HS: Complement and leukocyte-medicated pulmonary dysfunction in hemodialysis. N Engl J Med 296: 769, 1977PubMedCrossRefGoogle Scholar
  33. 33.
    Craddock PR, Fehr J, Dalmasso AP, Brigham KL, Jacobs HS: Hemodialysis leucopenia: pulmonary vascular leucostasis resulting from complement activation by dialyzer cellophane membranes. J Clin Invest 59: 879, 1977PubMedCrossRefGoogle Scholar
  34. 34.
    Amin Arnaout M, Hakim RM, Todd RF, Dana N, Colten HR: Increased expression of an adhesion-promoting surface glycoprotein in the granulocytopenia of hemodialysis. N Engl J Med 312: 457, 1985CrossRefGoogle Scholar
  35. 35.
    Horl WH, Jochum M, Heidland A, Fritz H: Release of granulocyte proteinases during hemodialysis. Am J Nephrol 3: 213, 1983PubMedCrossRefGoogle Scholar
  36. 36.
    Ritchey EE, Wallin JD, Shah SV: Chemiluminescence and superoxide anion production by leukocytes from chronic hemodialysis patients. Kidney Int 19: 359, 1981CrossRefGoogle Scholar
  37. 37.
    De Broe ME, Nouwen EJ, Van Waeleghem JP: On the mechanism and site of production of B2 microglobulin during hemodialysis. Nephrol Dial Transplant 2: 124, 1987PubMedGoogle Scholar
  38. 38.
    Cheung AK, Baranowski RL, Wayman AL: The role of thromboxane in cuprophan-induced pulmonary hypertension. Kidney Int 31: 1072, 1987PubMedCrossRefGoogle Scholar
  39. 39.
    Dumler F, Levin NW: Leucopenia and hypoxemia, unrelated effects of hemodialysis, Arch Intern Med 139: 1103, 1979PubMedCrossRefGoogle Scholar
  40. 40.
    Tolchin N, Roberts JL, Lewis EJ: Respiratory gas exchange by high efficiency hemodialyzer. Nephron 21: 137, 1978PubMedCrossRefGoogle Scholar
  41. 41.
    Brautbar N, Shinaberger JH, Miller JH, Nachman M: Hemodialysis hypoxemia: evaluation of mechanisms utilizing sequential ultrafiltration dialysis. Nephron 26: 96, 1980PubMedCrossRefGoogle Scholar
  42. 42.
    De Broe ME, De Backer WA, Verpooten GA, Vermeire PA, Van Waeleghem JP, Herman AG: Leucopenia and hypoxemia during hemodialysis with different types of membranes: effect of prostacyclin. Contr Nephrol 36: 26, 1983Google Scholar
  43. 43.
    Phillipson EA, Duffin J, Cooper JD: Critical dependence of respiratory rhythmicity on metabolic CO2 load. J Appl Physiol 50: 45, 1981PubMedGoogle Scholar
  44. 44.
    Kolobow T, Gattonini L, Tomlinson TA, Pierce JE: Control of breathing using an extracorporeal membrane lung. Anesthesiology 46: 138, 1977PubMedCrossRefGoogle Scholar
  45. 45.
    Ponte J, Purves MJ: CO2 and venous return and their interaction as stimuli to ventilation in the cat. J Physiol 274: 455, 1978PubMedGoogle Scholar
  46. 46.
    Sheldon ML, Green JF: Evidence for pulmonary CO2 chemosensitivity: effects on ventilation. J Appl Physiol 52:1192, 1982PubMedGoogle Scholar
  47. 47.
    Wasserman K, Whipp BJ, Casaburi R, Hutsman DJ, Dastagna J, Lugliani R: Regulation of arterial PCO2 during intravenous CO2 loading. J Appl Physiol 38: 651, 1975PubMedGoogle Scholar
  48. 48.
    Rodenstein DO, Mercenier C, Stanescu DC: Influence of the respiratory route on the resting breathing pattern in humans. Am Rev Respir Dis 131: 163, 1985PubMedGoogle Scholar
  49. 49.
    Abu-Hamdan DK, Desai SG, Mahajan SK, Muller BF, Briggs WA, Lynne-Davies P, McDonald FD: Hypoxemia during hemodialysis using acetate versus bicarbonate dialysate. Am J Nephrol 4: 248, 1984PubMedCrossRefGoogle Scholar
  50. 50.
    Heyrman RM, De Backer WA, Van Waeleghem JP, Willemen MJ, Vermeire PA, De Broe ME: Effect of oxygen administration on the breathing pattern during hemodialysis in man. Eur Resp J (in press)Google Scholar
  51. 51.
    Panzetta G, Tessitore N, Valvo E, Lupo A, Loschiavo C, Fabris A, Oldrizzi L, Gammaro L, Rugiu C, Bellotti Z, Maschio G: Biofiltration in the treatment of patients with acetate dialysis intolerance. Clin Nephrol 26: 33, 1986PubMedGoogle Scholar
  52. 52.
    West, JB: Man at extreme altitude. J Appl Physiol 52: 1399, 1982Google Scholar
  53. 53.
    Berssenbrugge A, Dempsey J, Iber C, Skatrud J, Wilson P: Mechanisms of hypoxia-induced periodic breathing during sleep in humans. J Physiol (Lond) 343: 507, 1983Google Scholar
  54. 54.
    De Backer WA, Heyrman RM, Wittesale WM, Waeleghem JP, Vermeire PA, De Broe ME: Ventilation and breathing patterns during hemodialysis induced carbon dioxide unloading. Am Rev Respir Dis 136: 406, 1987PubMedCrossRefGoogle Scholar
  55. 55.
    Berkenbosch A, Van Beek JHGM, Olievier CN, De Goede J, Quanjer PH: Central respiratory CO2, sensitivity at extreme hypoxapnia. Respir Physiol 55: 95, 1984PubMedCrossRefGoogle Scholar
  56. 56.
    Lahiri S, Hsiao C, Zhng R, Mokashi A, Nishino T: Peripheral chemoreceptors in respiratory oscillations. I Appl Physiol 58: 1901, 1985Google Scholar
  57. 57.
    Peres-Serrano A, Fernandeze-Vega F, Alvarez-Grande J: Hypoxemia during hemodialysis in patients with impairment in pulmonary function. Nephron 42: 14, 1986CrossRefGoogle Scholar
  58. 58.
    Camussi G, Segolini G, Rotunno M, Vercellone A: Mechanism involved in acute granulocytopenia in hemodialysis: Cell-membrane direct interactions. Int J Artif Organs 1: 123, 1978PubMedGoogle Scholar
  59. 59.
    Danielson BG, Hallgren R, Benge P: Neutrophil and eosinophil degranulation by hemodialysis membrane. Contrib Nephrol 37: 83, 1984PubMedGoogle Scholar
  60. 60.
    Hakim RM, Fearon DAT, Lazarus JM, Perzanowski CS: Biocompatibility of dialysis membranes: effect of chronic complement activation. Kidney Int 26: 194, 1984PubMedCrossRefGoogle Scholar
  61. 61.
    Greene WH, Casann RS, Mauer M, Quie P: The effect of hemodialysis on neutrophil chemotactic responsiveness. J Lab Clin Med 88: 971, 1976PubMedGoogle Scholar
  62. 62.
    Henderson LW, Miller ME, Hamilton RW, Norman ME: Hemodialysis leukopenia and polymorph random mobility — a possible correlation. J Lab Clin Med 85: 191, 1975PubMedGoogle Scholar
  63. 63.
    Chenoweth PE, Cheung AK, Henderson LW: Anaphylatoxin formation during hemodialysis: effects of different dialyzer membranes. Kidney Int 24: 764, 1983PubMedCrossRefGoogle Scholar
  64. 64.
    Lespier-Dexter LE, Guerra C, Ojeda W, Martinez-Maldonado M: Granulocyte adherence in uremia and hemodialysis. Nephron 24: 64, 1979PubMedCrossRefGoogle Scholar
  65. 65.
    McGregor RR: Granulocyte adherence changes induced by hemodialysis, endotoxin, epinephrine, and glucocorticoids. Ann Intern Med 86: 35, 1977Google Scholar
  66. 66.
    Hallgren R, Fjellstrom KE, Hakansson L, Venge P: Kinetic studies of phagocytosis. II. The serum-independent uptake of IgG-coated particles by polymorphonuclear leukocytes from uremic patients on regular dialysis treatment. J Lab Clin Med 94: 277, 1979PubMedGoogle Scholar
  67. 67.
    Hakim RM, Breillatt J, Lazarus JM, Port RK, Complement activation and hypersensitivity reaction to dialysis membranes. N Engl J Med 311:878, 1984PubMedCrossRefGoogle Scholar
  68. 68.
    Dinarello CA: The biology of interleukin-1 and its relevance to hemodialysis. Blood Purif 1: 197, 1983CrossRefGoogle Scholar
  69. 69.
    Lee J, Hakim RM, Fearon DT: Increased expression of the C3b receptor by neutrophils and complement activation during hemodialysis. Clin Exp Immunol 56: 205, 1984PubMedGoogle Scholar
  70. 70.
    Conger JD, Hammond WS, Alfrey AC, Contiguglia SR, Stanford RE, Huffer WE: Pulmonary calcification in chronic dialysis patients. Ann Intern Med 83: 330, 1975PubMedGoogle Scholar
  71. 71.
    Lee HY, Stretton TB, Barnes AM: The lungs in renal failure. Thorax 30: 46, 1975PubMedCrossRefGoogle Scholar
  72. 72.
    Schwarz A, Keller F, Seyfert S, Poll W, Molzahn M, Distler A: Carpal tunnel syndrome, a late complication in chronic hemodialysis. Deutsch Med Wochenschr 109: 285, 1984CrossRefGoogle Scholar
  73. 73.
    Allieu Y, Asencio G, Mailhe D, Baldet P, Mion C: Carpal tunnel syndrome in chronic hemodialysis patients. Rev Chir Orthop 69: 233, 1983PubMedGoogle Scholar
  74. 74.
    Bok DU, Pascular L, Herberger C, Sawyer R, Levin NW: Effect of multiple use of dialyzers on intradialytic symptoms. Proc Clin Dial Transplant Forum 10: 92, 1980PubMedGoogle Scholar
  75. 75.
    Kant KS, Pollak VE, Cathey M, Goetz D, Berlin R: Multiple use of dialyzers: safety and efficacy. Kidney Int 19: 728, 1981PubMedCrossRefGoogle Scholar
  76. 76.
    Man NK, Fournier G, Thireau P, Gaillard JL, Funck Brentano JL: The effect of bicarbonate containing dialysate on chronic hemodialysis patients: A comparative study. Artif Organs 6: 421, 1982PubMedGoogle Scholar
  77. 77.
    Chanard J, Brunois JP, Melin JP, Lavaud S, Toupance O: Long-term results of dialysis therapy with a highly permeable membrane. Artif Organs 6: 261, 1982PubMedCrossRefGoogle Scholar
  78. 78.
    Avram MM: The Long Island College Hospital experience with the decade or longer hemodialysis patient, in Prevention of Kidney Disease and Long-term Suvival edited by Avram MM, New York, London, Plenum Publ Co, 1982, p 165Google Scholar
  79. 79.
    Zidulka A, Despas PJ, Milic-Emili J, Anthonisen NR: Pulmonary function with acute loss of excess lung water by hemodialysis in patients with chronic uremia. Am J Med 55: 134, 1973PubMedCrossRefGoogle Scholar
  80. 80.
    Craig DB, Wahba WM, Don HF, Couture JG, Becklake MB: Closing volume and its relationship to gas exchange in seated and supine positions. J Appl Physiol 31: 717, 1971PubMedGoogle Scholar
  81. 81.
    Robson M, Levin A, Ravid M: Serial measurement of vital capacity in patients on chronic hemodialysis. Nephron 19: 60, 1977PubMedCrossRefGoogle Scholar
  82. 82.
    Brigham KL, Bernard G: Pulmonary complications of chronic renal failure. Semin Nephrol 1: 188, 1981Google Scholar
  83. 83.
    Kuzela DC, Huffer WE, Conger JD, Winter SD, Hammond WS: Soft tissue calcification in chronic dialysis patients. Am J Pathol 86: 403, 1977PubMedGoogle Scholar
  84. 84.
    Berlyne GM, Lee HA, Ralston AJ, Woodlock JA: Pulmonary complications of peritoneal dialysis. Lancet 2: 75, 1966PubMedCrossRefGoogle Scholar
  85. 85.
    Goggin MJ, Joekes AM: Pulmonary gas exchange during peritoneal dialysis. Br Med J 2: 247, 1971PubMedCrossRefGoogle Scholar
  86. 86.
    Ahluwalia M, Ishikawa S, Gellman M, Shah T, Sekar T, MacDonnel KF: Pulmonary functions during peritoneal dialysis. Clin Nephrol 18: 251, 1982PubMedGoogle Scholar
  87. 87.
    Khanna R, Oreopoulos DG: Complications of peritoneal dialysis other than peritonitis, in Peritoneal Dialysis, edited by Nolph KD, The Hague, Martinus Nijhoff, 1985, p 441Google Scholar
  88. 88.
    Freedman S, Maberly DJ: Pulmonary gas exchange during dialysis. Br Med J 3: 48, 1971PubMedCrossRefGoogle Scholar
  89. 89.
    Taveira Da Silva AM, Davis WB, Winchester JF, Coleman DE, Wei CW: Peritonitis, dialysate infusion and lung function in continuous ambulatory peritoneal (CAPD) Clin Nephrol 24: 79, 1985Google Scholar
  90. 90.
    O’Brien AAJ, Power J, O’Brien L, Clancy L, Keogh J AB: The effect of 2 L dialysate on respiratory function. Peritoneal Dial Bull 7: S57, 1987Google Scholar
  91. 91.
    Scheldewaert R, Bogaerts Y, Pauwels R, Van der Straeten M, Ringoir S, Lameire N: Management of a massive hydrothorax in a CAPD patient: a case report and a review of the literature. Peritoneal Dial Bull 2: 69, 1982Google Scholar

Copyright information

© Kluwer Academic Publishers 1989

Authors and Affiliations

  • Marc E. de Broe
  • Robert R. Lins
  • Wilfried A. De Backer

There are no affiliations available

Personalised recommendations