Common pleuro-pulmonary complications of uremic patients under hemodialysis

ABSTRACT

The current study was conducted in hemodialysis unit - Minufiya University Hospital to detect common pleuro-pulmonary complications in uremic patients under regular hemodialysis. This study included 20 patients [8 males, 12 females] with mean age of [44.6 -/+ 13.78] years on regular thrice weekly hemodialysis for a period 6 months .We excluded from the study smokers,other diseases that affect chest, non compliant patients during the period of study and patients who received recombinant human erythropoietin. All patients were subjected to full history taking, full clinical examination, renal function tests, complet blood picture, arterial blood gases analysis, radialogical study of chest and heart, spirometric study. In this study about 55% of the patients showed pulmonary complications in the form of bronchopneumonia, acute bronchitis, lobar pneumonia, pleural effusion, tuberculosis and pulmonary oedema. The caustive organisms in these cases of pulmonary infection were Staphylococcus aureus, Streptococcus viridans haemophillus, pneumococci and tuberculous bacilli. Pleural effusion was transudative in nature. The PaO[2] was significantly decrease after 1 hour from begining of hemodialysis. This was due to hypoventilation caused by decrease CO[2] due to its loss in dialysis fluid, alkalosis and use of bioincompatable membranes. As regards spirometric measures, there was no significant improvement of VC, FVC, FEV[1] /FVC, MMV where as improvement in FEF [25-75%] was significant This is due to removal of interstial, peribronchial fluid by hemodialysis with removal of toxins that impair distensibility and causes reversible spasm to smaller airways. Also there was signifcant fall in PEFR one hour after the start of hemodialysis. This is correlated with occurence of hypoxaemia and broncho-constriction which occur at that time, although there was significant improvement of PEFR after hemodialysis but not correlated to normal values. Recommendations include use of non complement activating membrane and a dialysis system in which loss of carbon dioxide can be prevented, measuring spirometric variables before and after dialysis and close observation both clinically and radiologically, for these patients