A Spectrum of Pulmonary Complications Occurring in End-Stage Renal Disease Patients on Maintenance Hemodialysis.

Likhita Shaik,Rutul N Shah,Rashmi Subramani,Romil Singh,Sahith Reddy Thotamgari,Renuka R Katta,Parneet Kaur,Abdul Mukhtadir Kalaiger,Shaheryar Ranjha,Praveen Kowtha

doi:10.7759/cureus.15426

Abstract

ObjectiveTo investigate the trends of end-stage renal disease (ESRD) in patients undergoing maintenance hemodialysis (MHD) and find the correlation with effects on the pulmonary system in such patients.MethodologyA multicentric prospective study was conducted in the city of Solapur, India. Data were collected from 250 patients through interpersonal interrogation using a questionnaire to capture basic demographic details, the history of ESRD, and relevant respiratory symptoms like breathlessness, cough, fever, etc. related to their disease. Symptoms that are likely associated with the pulmonary system were analyzed and referred to the pulmonology department. Appropriate diagnoses were made using relevant diagnostic tools like X-rays and sputum studies. The association between various disease attributes and pulmonary diagnoses was analyzed using the chi-square (χ2) test, with a p-value of value less than or equal to 0.05 considered statistically significant. Various socio-demographic variables, existing comorbidities, occupation-related risk factors, smoking history, past or current history of any respiratory conditions, the association between the causes of ESRD, time since the first dialysis and sociodemographic factors, and frequency of pulmonary complications were the other covariates in the study.ResultsOur study reports that 31.6% of our patients had significant impairment in their functioning due to respiratory complaints. The prevalence of respiratory complications was 27.2%. Major contributors were pleural effusion (33.8), pneumonia (25), pulmonary edema (20.58), pleuritis (11.76), collapse (8.8), tuberculosis (5.8), fibrosis (4.4), pericardial effusion (4.4), calcification (2.9), and hydrothorax (1.47). We report one case of Urinothorax as a rare cause of hydrothorax in such patients. Overall, our analysis found a significant association between non-reporting of respiratory complaints and acute admissions to the intensive care unit (ICU) with a respiratory cause at p-value 0.0076 with a greater predilection toward the rural populations.ConclusionOur study results highlight the prevalence of pulmonary complications in ESRD patients. The occurrence of pulmonary complications, irrespective of the presence of symptoms and a greater association between non-reporting of respiratory symptoms and acute admissions to the ICU, is a hallmark to consider the importance of history and clinical vigilance during patient visits.

Highlights

End-stage renal disease (ESRD) is defined as an irreversible decline in kidney function, which would otherwise require renal replacement therapy [1,2]
Our analysis found a significant association between non-reporting of respiratory complaints and acute admissions to the intensive care unit (ICU) with a respiratory cause at p-value 0.0076 with a greater predilection toward the rural populations
The occurrence of pulmonary complications, irrespective of the presence of symptoms and a greater association between nonreporting of respiratory symptoms and acute admissions to the ICU, is a hallmark to consider the importance of history and clinical vigilance during patient visits

Summary

Introduction

End-stage renal disease (ESRD) is defined as an irreversible decline in kidney function, which would otherwise require renal replacement therapy (dialysis or transplantation) [1,2]. National Kidney Foundation Kidney Disease Outcomes Quality Initiative classification of chronic kidney disease (CKD) as glomerular filtration rate (GFR) less than 15 ml/min/1.73 m2 of body surface area and severely increased albuminuria (>300 mg/g of albumin creatinine ratio or >300 mg of albumin excretion rate in 24 hours) or those requiring renal replacement therapy irrespective of GFR/albuminuria. Such a significant decline in kidney function can lead to a multitude of physiological changes, including fluid retention, cardiovascular complications, respiratory complications, dyselectrolytemia, and anemia [3]

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