Diaphragmatic dysfunction associates with dyspnoea, fatigue, and hiccup in haemodialysis patients: a cross-sectional study

Bin Wang,Yuchen Han,Hong Liu,Ying-Yan Wang,Yufang Xue,Min Gao,Qing Yin,Liuping Zhang,Mingming Pan,Yan Tu,Li Zhang,Yan Yang,Xiaoliang Zhang,Bi-Cheng Liu,Rining Tang,Xiaonan H Wang,Jingjie Xiao

doi:10.1038/s41598-019-56035-4

Abstract

Muscle wasting is associated with increased mortality and morbidity in chronic kidney disease (CKD) patients, especially in the haemodialysis (HD) population. Nevertheless, little is known regarding diaphragm dysfunction in HD patients. We conducted a cross-sectional study at the Institute of Nephrology, Southeast University, involving 103 HD patients and 103 healthy volunteers as normal control. Ultrasonography was used to evaluate diaphragmatic function, including diaphragm thickness and excursion during quiet and deep breathing. HD patients showed lower end-inspiration thickness of the diaphragm at total lung capacity (0.386 ± 0.144 cm vs. 0.439 ± 0.134 cm, p < 0.01) and thickening fraction (TF) (0.838 ± 0.618 vs. 1.127 ± 0.757; p < 0.01) compared to controls. The velocity and excursion of the diaphragm were significantly lower in the HD patients during deep breathing (3.686 ± 1.567 cm/s vs. 4.410 ± 1.720 cm/s, p < 0.01; 5.290 ± 2.048 cm vs. 7.232 ± 2.365 cm; p < 0.05). Changes in diaphragm displacement from quiet breathing to deep breathing (△m) were lower in HD patients than in controls (2.608 ± 1.630 vs. 4.628 ± 2.110 cm; p < 0.01). After multivariate adjustment, diaphragmatic excursion during deep breathing was associated with haemoglobin level (regression coefficient = 0.022; p < 0.01). We also found that the incidence of dyspnoea and hiccup and the fatigue scores, all of which were related to diaphragmatic dysfunction, were significantly higher in HD patients than in controls (all p < 0.01). Improving diaphragm function through targeted therapies may positively impact clinical outcomes in HD patients.

Highlights

Muscle wasting is associated with increased mortality and morbidity in chronic kidney disease (CKD) patients, especially in the haemodialysis (HD) population
Diaphragmatic dysfunction is prevalent in many diseases, including chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and diseases requiring intensive care, especially mechanical ventilation[6]
We found that the velocity of diaphragm movement www.nature.com/scientificreports dyspnoea Age TdiTLC diaphragm excursion at TLC (DMTLC) △m thickening fraction (TF) Hypertension Hb (g/L) Alb (g/L) Glu CCB Coronary heart disease (CHD) CHF DM

Summary

Introduction

Muscle wasting is associated with increased mortality and morbidity in chronic kidney disease (CKD) patients, especially in the haemodialysis (HD) population. Ultrasonography was used to evaluate diaphragmatic function, including diaphragm thickness and excursion during quiet and deep breathing. We found that the incidence of dyspnoea and hiccup and the fatigue scores, all of which were related to diaphragmatic dysfunction, were significantly higher in HD patients than in controls (all p < 0.01). Several techniques, including fluoroscopy, phrenic nerve stimulation, dynamic magnetic resonance imaging of the diaphragm, and trans-diaphragmatic pressure measurement, can be used to assess diaphragmatic function[12] Each of these techniques has its own limitations and drawbacks such as exposure to ionizing radiation, low availability, invasiveness, and the need for patient transportation. Diaphragm function, including diaphragm thickness and diaphragm excursion, can be evaluated by instant monitoring using ultrasound[14]

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