PURPOSE: According to the medical literature, prolonged renal failure or hemodialysis treatment might have thoracic and pulmonary effects, such as caused decreased diffusion capacity and metastatic calcifications. Prompted by the successful transplantation at our center of two lungs from a donor who had been on long-term hemodialysis, we sought to determine if hemodialysis does indeed affect pulmonary function.
METHODS: The study group included 18 patients aged 27 to 93 years (mean 67.4 years, standard deviation 16 years) treated with hemodialysis from 33 to 257 months (average 77.6 months, standard deviation 4.7 months). Immediately following a dialysis session, the patients underwent lung function tests, cardiopulmonary exercise test, and 6-minute walk test, non-contrast high- resolution computed tomography scanning of the chest and echocardiography. Findings were compared to predicted values.
RESULTS: Fourteen patients (77.8%) had normal values on lung function tests. Of the remainder, 1 patient had a nearly normal restrictive pattern, 2 patients had a mild restrictive dysfunction, and 1 patient had a moderate restrictive dysfunction. Decreased diffusion capacity was noted in 11 patients (68.8%) –mild in 10 and moderate in 1 (48% of normal values). The distance on the 6-minute walk test measured less than 350 meters in 7 patients (38.9%), with no decrease in oxygen saturation. Echocardiograms demonstrated moderate to severe left ventricular dysfunction in 3 patients (16.7%); only 1 patient had right ventricular dysfunction. Mild pulmonary hypertension was measured in 4 patients (22.2%), and severe pulmonary hypertension in 1. Computed tomography findings possibly compatible with metastatic calcifications (bronchial calcifications, ground glass opacifications and/or pulmonary nodules) were noted in 15 patients (66.7%).
CONCLUSION: Prolonged hemodialysis is apparently not associated with pulmonary dysfunction. Although most of the patients in our series had poor physical fitness, consistent with reports in the literature, the possible calcification noted on computed tomography was mild and apparently not clinically significant.
CLINICAL IMPLICATIONS: On the basis of these findings, we suggest that patients on hemodialysis may be considered as potential lung donors.
DISCLOSURE: Dekel Shlomi, No Financial Disclosure Information; No Product/Research Disclosure Information