Pulmonary Functions in Patients with End Stage Renal Disease and their Effect after Hemodialysis.

OBJECTIVE To determine the pulmonary functions in patients with End Stage Renal Disease (ESRD) and the associated factors including the acute effects of hemodialysis. STUDY DESIGN Observational, cross-sectional study. Place and Duration of Study: Nephrology Department in collaboration with Pulmonology Department, Shalamar Hospital, Lahore,  from October to November 2019. METHODOLOGY  All patients of age 18-75 years, on regular hemodialysis (HD) for more than three months, who quitted smoking 10 years back and stable, were included in the study. Demographic data was collected and blood samples were sent for hematological and biochemical laboratory parameters. Pulmonary functions were assessed by spirometry for Forced Vital Capacity (FVC) and Forced Expiratory Volume in first second (FEV1) and FVC/FEV1 before and after dialysis. RESULTS  Out of 102 patients, 62 (60.8%) were males and 79 (77.5%) were on twice-weekly dialysis. DM 44 (43.1%) and chronic glomerulonephritis 21 (19.5%) were the major causes of ESRD in these patients. In this study, FVC and FEV1 were abnormal in majority of the patients 73 (71.6%) and 76 (74.5%), which was statistically significant (p<0.05) supporting restrictive lung disease (RLD). Factors associated with RLD were male gender (p=0.006) and diabetes mellitus (p=0.003). Hemodialysis did not improve pulmonary functions significantly. FEV1 and FVC had a negative correlation with age and body mass index (BMI). CONCLUSION Restrictive lung disease is the most common pulmonary dysfunction among ESRD patients.  Factors associated with pulmonary dysfunctions were male gender and diabetes mellitus. Hemodialysis did not improve pulmonary functions. Key Words: ESRD, Pulmonary functions, Restrictive lung disease, Fluid overload.