Skip to main content
SpringerLink
Log in

Effect of peritoneal dialysis vs. haemodialysis on respiratory mechanics in acute kidney injury patients

  • Original article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

Peritoneal dialysis (PD) and hemodialysis (HD) are options for the treatment of acute kidney injury (AKI) patients. The aim of this study was to compare the effects of PD and daily HD on respiratory mechanics of AKI patients undergoing invasive mechanical ventilation (IMV).

Methods

A prospective cohort study evaluated 154 patients, 37 on continuous PD and 94 on HD. Respiratory mechanics parameters such as pulmonary static compliance (Psc) and resistance of the respiratory system (Rsr) and oxygenation index (OI) were assessed for 3 days. Patients were evaluated at moments 1, 2 and 3 (pre- and post-dialysis).

Results

The initial clinical parameters were similar in the two groups, except the age that was higher in continuous PD group (70.8 ± 11.6 vs. 60 ± 15.8; p < 0.0001). In both groups, Psc increased significantly, with no difference between the two groups—pre-dialysis (continuous PD 40 ± 17.4, 42.8 ± 17.2, 48 ± 19; HD 39.1 ± 21.3, 39. 5 ± 18.9, 45.2 ± 21) and post-dialysis (continuous PD 42.8 ± 7.2, 48 ± 19, 57.1 ± 18.3; HD 42 ± 19, 45 ± 18.5, 56 ± 24.8). Rsr remained stable among patients on continuous PD (pre-dialysis 10.4 ± 5.1, 13.3 ± 7.7, 13.5 ± 10.3, post-dialysis 13.3 ± 7.7, 13.5 ± 10.3, 11.1 ± 5.9) and decreased among HD patients (pre-dialysis 10.4 ± 5.1, 10.4 ± 5.1, 10.4 ± 5, 1, post-dialysis 10.5 ± 6.8, 10 ± 4.9, 8.9 ± 4.2). There was difference in Rsr between the two groups at the post-dialysis moments 1 and 2 (p = 0.03). OI increased in both groups (continuous PD 260.7 ± 119, 252.7 ± 87.1, 287.3 ± 88.4; HD 228 ± 85, 257 ± 84, 312.1 ± 111.5, p > 0.05), although there was no difference between them.

Conclusion

AKI patients undergoing IMV and HD or PD had improvement in the mechanical ventilation and oxygenation, with no difference between the two groups.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hoste EA, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI_EPI study. Intensive Care Med. 2015;41:1411–23.

    Article  Google Scholar 

  2. Ko GJ, Tabb H, Hassoun HT. Kidney-lung crosstalk in critically ill patient. Blood Purif. 2009;28:75–83.

    Article  Google Scholar 

  3. Ponce D, Caramori JCT, Balbi AL, Barretti P. Peritoneal dialysis in acute kidney injury: Brazilian experience. Perit Dial Int. 2012;32:242–3.

    Article  Google Scholar 

  4. Ponce D, Berbel MN, Regina de Goes C, Almeida CTP, Balbi AL. High-volume peritoneal dialysis in acute kidney injury: indications and limitations. Clin J Am Soc Nephrol. 2012;7(6):887–94.

    Article  Google Scholar 

  5. Gabriel DP, Balbi AL, Amerling R. Advances in peritoneal dialysis in acute kidney injury. Blood Purif. 2012;34:107–16.

    Article  Google Scholar 

  6. Ponce D, Berbel MN, Abrão JMG, Goes CR, Balbi AL. A randomized clinical trial of high-volume peritoneal dialysis versus extended daily hemodialysis for acute kidney injury patients. Int Urol Nephrol. 2012;1:1–10.

    Google Scholar 

  7. Ponce D, Balbi AL. Peritoneal dialysis in acute kidney injury: a viable alternative. Perit Dial Int. 2011;31:387–9.

    Article  Google Scholar 

  8. Goes CR, Berbel MN, Balbi AL, Ponce D. Metabolic implications of peritoneal dialysis in acute kidney injury patients. Perit Dial Int. 2013 (accepted for publication).

  9. Gavelli G, Zompatori. Thoracic complications in uremic patients and in patients undergoing dialytic treatment: state of the art. Eur Radiol. 1997;7:708–17.

    Article  CAS  Google Scholar 

  10. Hughes GC, Ketchersid TL, Lenzen JM, Lowe JE. Thoracic complications of peritoneal dialysis. Ann Thorac Surg. 1999;67:1518–22.

    Article  CAS  Google Scholar 

  11. Mahale AS, Katyal A, Khanna R. Complications of peritoneal dialysis related to increased intra-abdominal pressure. Adv Perit Dial. 2003;19:130–5.

    PubMed  Google Scholar 

  12. Pelosi P, Quintel M, Malbrain ML. Effect of intra-abdominal pressure on respiratory mechanics. Acta Clin Belg. 2007;62(1):78–88.

    Article  Google Scholar 

  13. Toens CH, Schachtrupp A, Hoer J, Junge K, Klosterhalfen B, Schumpelick V. Porcine model of abdominal compartment syndrome. Shock. 2002;18:37–45.

    Article  Google Scholar 

  14. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network (AKIN): report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:31–8.

    Article  Google Scholar 

  15. Macedo E, Mehta RL. When should renal replacement therapy be initiated for acute kidney injury? Semin Dial. 2011;24:132–7.

    Article  Google Scholar 

  16. KDIGO kidney disease improving global outcomes. Clinical practice guideline for acute kidney. Kidney Int Suppl 2012;2:1e138.

    Google Scholar 

  17. Levy P, Similowski T, Corbeil C, et al. A method for studying the static volume-pressure curves of the respiratory system during mechanical ventilation. J Crit Care. 1989;4:83–9.

    Article  Google Scholar 

  18. Grinnan DC, Truwit JD. Clinical review: respiratory mechanics in spontaneous and assisted ventilation. Crit Care. 2005;9:472–84.

    Article  Google Scholar 

  19. Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, et al. Monitoring sedation status over time in ICU patients—reliability and validity of the Richmond Agitation—Sedation Scale (RASS). JAMA. 2003;289:2983–91.

    Article  Google Scholar 

  20. Gilbert R, Keighley JF. The arterial/alveolar oxygen tension ratio. An index of gas exchange applicable to varying inspired oxygen concentrations. Am Rev Respir Dis. 1974;109:142.

    CAS  PubMed  Google Scholar 

  21. Kron IL, Harman PK, Nolan SP. Measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984;199:28–30.

    Article  CAS  Google Scholar 

  22. Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Intensive Care Med. 2007;33:951–62.

    Article  Google Scholar 

  23. Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, et al. Incidence e prognosis of intra-abdominal hypertension in a mixed population of critically ill patients. A multiple-center epidemiology study. Crit Care Med. 2005;33(2):315–22.

    Article  Google Scholar 

  24. Torquato J, Lucato JJJ, Antunes T, Barbas CV. Interaction between intra-abdominal pressure and positive-end expiratory pressure. Clinics. 2009;64(2):105–12.

    Article  Google Scholar 

  25. Bunchman TE, et al. Pulmonary function variation in ventilator dependent critically ill infants on peritoneal dialysis. Adv Perit Dial. 1992;8:75–8.

    CAS  PubMed  Google Scholar 

  26. Morris KP, Butt WW, Karl TR. Effect of peritoneal dialysis on intra-abdominal pressure and cardio-respiratory function in infants following cardiac surgery. Cardiol Young. 2004;14(3):293 – 98.

    Article  CAS  Google Scholar 

  27. Almeida CP, Ponce D, De Marchi AC, Balbi AL. Effect of peritoneal dialysis on respiratory mechanics in acute kidney injury patients. Perit Dial Int. 2014;34(5):544–9.

    Article  Google Scholar 

  28. Lewis CA, Martin GS. Understanding and managing fluid balance in patients with acute lung injury. Curr Opin Crit Care. 2004;10(1):13–7.

    Article  Google Scholar 

  29. Prowle JR, Echeverri JE, Ligabo EV, et al. Fluid Balance and acute kidney injury. Nat Rev Nephrol. 2010;6:107–15.

    Article  Google Scholar 

  30. Payen D, Pont AC, Sakr Y, et al. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care. 2008;12:74–80.

    Article  Google Scholar 

  31. Werner HA, Wensley DF, Lirenman DS, et al. Peritoneal dialysis in children after cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1997;113:64–70.

    Article  CAS  Google Scholar 

  32. Bokariia LA, et al. Peritoneal dialysis in the newborn and infants after radical correction of complex congenital heart defects. Anestesiol Reanimol. 2002;2:42–8.

    Google Scholar 

  33. Lopes FM, Ferreira JR, Flores DG. Impacto da terapia renal substitutiva na função respiratória de pacientes sob ventilação mecânica. Rev bras ter intensiva. 2013;25(3):1–10.

    Article  Google Scholar 

  34. Huang CC, et al. Respiratory drive and pulmonary mechanics during haemodialysis with ultrafiltration in ventilated patients. Anaesth Intensive Care. 1997;25:464–70.

    CAS  PubMed  Google Scholar 

  35. Stein B, Pfenninger E, Guünert A, et al. The consequences of continuous haemofiltration on lung mechanics and extravascular lung water in a porcine endotoxic shock model. Intensive Care Med. 1991;17(5):293–8.

    Article  CAS  Google Scholar 

  36. Lu GP, et al. Effect of continuous veno-venous hemodiafiltration on endotoxin-induced acute lung injury of the piglets. Pediatr Crit Care Med. 2011;12(2):73–8.

    Article  Google Scholar 

  37. Steinhorst RC, Vieira JM, Abdulkader RCRM.. Acute effects of intermittent hemodialysis and sustained low-efficiency hemodialysis (SLED) on the pulmonary function of patients under mechanical ventilation. Renal Fail. 2007;29:341–5.

    Article  Google Scholar 

  38. Huang CC, Lin MC, Yang CT, et al. Oxygen, arterial blood gases and ventilation are unchanged during dialysis in patients receiving pressure support ventilation. Respir Med. 1998;92:534–40.

    Article  CAS  Google Scholar 

  39. Pierson DJ. Respiratory considerations in the patient with renal failure. Respir Care. 2006;51(4):413–22.

    PubMed  Google Scholar 

  40. Harper SJ, Tomson CRV, Bates DO. Human uremic plasma increases microvascular permeability to water and protein in vivo. Kidey Int. 2002;61:1416–22.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Botucatu Medical School, UNESP, Univ Estadual Paulista, Botucatu, Brazil

    Cibele Puato Almeida, André Luís Balbi & Daniela Ponce

Authors
  1. Cibele Puato Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. André Luís Balbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Ponce
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniela Ponce.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Almeida, C.P., Balbi, A.L. & Ponce, D. Effect of peritoneal dialysis vs. haemodialysis on respiratory mechanics in acute kidney injury patients. Clin Exp Nephrol 22, 1420–1426 (2018). https://doi.org/10.1007/s10157-018-1598-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-018-1598-7

Keywords

Search

Navigation